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Comment
. 2017 Feb;66(2):384-386.
doi: 10.1136/gutjnl-2016-311796. Epub 2016 Apr 7.

Vonoprazan Helicobacter pylori eradication therapy: ethical and interpretation issues

David Y Graham
Comment

Vonoprazan Helicobacter pylori eradication therapy: ethical and interpretation issues

David Y Graham. Gut. 2017 Feb.
No abstract available

Keywords: ANTIBIOTIC THERAPY; CLINICAL TRIALS; HELICOBACTER PYLORI.

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Figures

Figure 1
Figure 1
Results of vonoprazan and lansoprazole triple therapy with clarithromycin susceptible and resistant infections. Clarithromycin resistance effectively turns the regimens into a dual antisecretory drug-amoxicillin therapy. Amox, amoxicillin; PPI, proton pump inhibitor; vono, vonoprazan.
Figure 2
Figure 2
Hp-normogram. This normogram plots the cure rate with susceptible infections on the left vertical axis and those with resistant infections on the right vertical axis. The proportion with resistance is shown on the horizontal axis. The cure rates are connected with a line allowing one to visualise the population cure rates for any prevalence of resistance. This plot shows the cure rates with vonoprazan and lansoprazole triple therapies (cure rate with susceptible strains of 97% for both and 82% vs 40% for vonoprazan and lansoprazole, respectively. Note that the lines diverge such that at 15% clarithromycin resistance the cure rates would differ by only 6%.
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References

    1. Murakami K, Sakurai Y, Shiino M, et al. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut 2016;65: 1439–46. - PMC - PubMed
    1. Graham DY. Editorial—Avoiding unethical Helicobacter pylori clinical trials: susceptibility-based studies and probiotics as adjuvants. Helicobacter 2015;20:321–5. - PMC - PubMed
    1. Pounder RE, Talley NJ. Letter: the ethics of using inferior regimens in H. pylori randomised trials—editors’ reply. Aliment Pharmacol Ther 2012;35:858. - PubMed
    1. Graham DY. Hp-normogram (normo-graham) for assessing the outcome of H. pylori therapy: Effect of resistance, duration, and CYP2C19 genotype. Helicobacter 2016;21:85–90. - PubMed
    1. Dore MP, Lu H, Graham DY. Role of bismuth in improving Helicobacter pylori eradication with triple therapy. Gut 2016;65:870–8. - PubMed

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