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. 2016 Sep;59(2):149-153.
doi: 10.3164/jcbn.16-18. Epub 2016 Jul 16.

Esomeprazole- or rabeprazole-based triple therapy eradicated Helicobacter pylori comparably regardless of clarithromycin susceptibility and CYP2C19 genotypes

Tadayoshi Okimoto  1 , Kazuhiro Mizukami  1 , Ryo Ogawa  1 , Kazuhisa Okamoto  1 , Mitsutaka Shuto  1 , Kensuke Fukuda  1 , Masaaki Kodama  1 , Kazunari Murakami  1
Affiliations

Esomeprazole- or rabeprazole-based triple therapy eradicated Helicobacter pylori comparably regardless of clarithromycin susceptibility and CYP2C19 genotypes

Tadayoshi Okimoto et al. J Clin Biochem Nutr. 2016 Sep.

Abstract

The aim of this study was to assess the efficacy of esomeprazole-based triple therapy compared with rabeprazole-based triple therapy according to CYP2C19 genotype and clarithromycin susceptibility status for first-line eradication therapy of Helicobacter pylori (H. pylori) in Japan. We enrolled 219 H. pylori-infected patients, and randomly allocated patients to the EAC group (esomeprazole 20 mg, clarithromycin 200 mg, amoxicillin 750 mg for one week, with all drugs given twice daily) or RAC group (rabeprazole 10 mg, clarithromycin 200 mg, amoxicillin 750 mg for one week, with all drugs given twice daily). The H. pylori eradication rate according to the PP analyses was 75.0% (95% CI: 65.2-82.8%) in the EAC group and 71.4% (95% CI: 61.4-79.1%) in the RAC group. There were no statistically significant differences. The eradication rates of the clarithromycin-resistant/-sensitive strains were, respectively, 45.0% (95% CI: 30.7-60.2%)/98.0% (95% CI: 88.7-100%) in the EAC group and 39.5% (95% CI: 25.6-55.3%)/93.5% (95% CI: 81.9-98.4%) in the RAC group. The eradication rate of the clarithromycin-sensitive strains was significantly higher than that of the resistant strains in both groups. In conclusion, EAC and RAC therapies show a comparable efficacy regardless of the CYP2C19 genotype and clarithromycin susceptibility status in Japan.

Keywords: CYP2C19; Helicobacter pylori; eradication; esomeprazole; rabeprazole.

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Conflict of interest statement

No potential conflicts of interest were disclosed.

Figures

Fig. 1
Fig. 1
Study flow chart. Patients were randomly assigned the patients to the EAC group (n = 108) or RAC group (n = 111). Sixteen patients in the EAC group and 20 patients in the RAC group were lost to follow-up. EAC, esomeprazole in combination with amoxicillin and clarithromycin; RAC, rabeprazole in combination with amoxicillin and clarithromycin.
Fig. 2
Fig. 2
Eradication rates of according to CYP2C19 genotype in the per protocol analysis. The eradication rates were compared in three CYP2C19 genotypes, Homo-EM, Hetero-EM, Poor metabolizer. Homo-EM, homozygous extensive metabolizer; Hetero-EM, heterozygous extensive metabolizer; EAC, esomeprazole in combination with amoxicillin and clarithromycin; RAC, rabeprazole in combination with amoxicillin and clarithromycin.
Fig. 3
Fig. 3
Clarithromycin resistance and eradication rates in the per protocol analysis. The eradication rates were compared according to the clarithromycin susceptibility status. EAC, esomeprazole in combination with amoxicillin and clarithromycin; RAC, rabeprazole in combination with amoxicillin and clarithromycin; CAM-S, clarithromycin sensitive; CAM-R, clarithromycin resistant; *p<0.001.
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