Vonoprazan-based triple therapy is effective for Helicobacter pylori eradication irrespective of clarithromycin suscepti
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ORIGINAL ARTICLE—ALIMENTARY TRACT
Vonoprazan-based triple therapy is effective for Helicobacter pylori eradication irrespective of clarithromycin susceptibility Hidetaka Okubo1 • Junichi Akiyama1 • Masao Kobayakawa1 • Megumi Kawazoe1 Saori Mishima1 • Yusuke Takasaki1 • Naoyoshi Nagata1 • Takayuki Shimada1 • Chizu Yokoi1 • Shiori Komori1 • Kana Kimura1 • Yuya Hisada1 • Eri Iwata1 • Kazuhiro Watanabe1 • Naohiro Yanagisawa1 • Sho Shiroma1 • Akira Shimomura1 • Koki Okahara1 • Hourin Cho1 • Naomi Uemura1
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Received: 27 January 2020 / Accepted: 31 August 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Helicobacter pylori causes peptic ulcers and accounts for over 90% of gastric cancers; however, eradication rates have been declining due to antimicrobial resistance. Vonoprazan (VPZ), a potassium-competitive acid blocker, produces rapid and profound gastric acid suppression and has shown promising effects in the improvement of H. pylori eradication rates. The efficacy and safety of VPZ-based triple therapy as a first-line regimen for H. pylori eradication and its relationship with clarithromycin (CAM) susceptibility were evaluated. Methods From May 2015 to September 2017, H. pyloriinfected patients who underwent esophagogastroduodenoscopy with CAM susceptibility testing were prospectively enrolled. Patients received a 7-day triple therapy regimen (VAC) of VPZ (20 mg), amoxicillin (750 mg), and CAM (200 mg) twice daily. Eradication rates, demographics, CAM susceptibility, and safety profiles were assessed. Results VAC was administered to 146 patients (median age: 63, range: 22–85 years) (60% of whom were females) who underwent CAM susceptibility testing, and 131 patients underwent 13C-urea breath testing to evaluate eradication success. The prevalence of CAM resistance was 34.2%. The overall eradication rates of VAC in per protocol (PP) and ‘‘intention to treat’’ (ITT) analyses were 90.8% (n = 131) and 81.5% (n = 146), respectively. In PP analysis for CAM susceptibility, the eradication rates of
& Hidetaka Okubo [email protected] 1
Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
VAC were comparable between CAM-sensitive (91.6%, n = 83) and CAM-resistant (89.4%, n = 47) strains. The corresponding rates from the ITT analysis were 80.0% (n = 95) and 84.0% (n = 50), respectively. No adverse events requiring discontinuation of VAC were observed. Conclusions CAM-resistant H. pylori was prevalent in one-third of patients in the Tokyo metropolitan area. VPZbased triple therapy was highly effective and well-tolerated irrespective of CAM susceptibility. Therefore, it could be a valuable first-line treatment regimen for H. pylori infection. Keywords Vonoprazan H. pylori eradication Clarithromycin resistance Triple therapy
Introduction Helicobacter pylori infection is known to cause upper gastrointestinal diseases such as chronic gastritis, peptic ulcers, and gastric cancer. H. pylori accounts for [ 90% of
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