Esomeprazole- or Rabeprazole-Based Triple Therapy Eradicated Helicobacter pylori Comparably, Regardless of Clarithromycin Susceptibility and CYP2C19 Genotypes

Abstract

Introduction: 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 in Japan. Methods: For this multicenter, prospective, randomized, controlled study, we enrolled 219 H. pyloriinfected patients from 6 participating hospitals in Japan. We 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). Successful eradication was evaluated using the urea breath test at 4 to 8 weeks after completing the eradication therapy. Results: 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 between the two groups. The eradication rates did not vary with the CYP2C19 genotype. 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 clarithromycin resistant strains in both EAC (P P < 0.001) groups. Conclusion: In conclusion, EAC and RAC therapies for H. pylori show a comparable efficacy regardless of the CYP2C19 genotype and clarithromycin susceptibility status in Japan.Figure 1