A Prospective Randomized Trial of Esomeprazole- versus Pantoprazole-Based Triple Therapy for Helicobacter pylori Eradication

Hsu, Ping‐I; Lai, Kwok‐Hung; Lin, Chiun‐Ku; Chen, Wen‐Chi; Yu, Hsien‐Chung; Cheng, Jin‐Shiung; Tsay, Feng‐Woei; Wu, Chung-Jen; Lo, Ching‐Chu; Tseng, Hui‐Hwa; Yamaoka, Yoshio; Chen, Jinliang; Lo, Gin‐Ho

doi:10.1111/j.1572-0241.2005.00264.x

Cited by 54 publications

(49 citation statements)

References 25 publications

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“…That report also suggested that neither esomeprazole dosage nor dosing duration have additive effects on H. pylori eradication rates. Although some reports have shown that esomeprazole at 20 mg has an H. pylori eradication rate similar to that of omeprazole at 20 mg,63,64 the rate has also been shown to significantly differ between esomeprazole-based and other PPI-based regimens, such as pantoprazole-based treatment (ITT analysis: 94% vs 82%; P = 0.009) 65…”

Section: H Pylori Eradication Therapy In Japanmentioning

confidence: 96%

Efficacy of esomeprazole in treating acid-related diseases in Japanese populations

Sugimoto¹,

Furuta²

2012

CEG

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Esomeprazole (Nexium®; AstraZeneca), the S-isomer of omeprazole, is the first proton pump inhibitor (PPI) to be developed as an optical isomer. Compared with omeprazole, esomeprazole has an improved pharmacokinetic profile with regards to CYP2C19 (S-mephenytoin 4′-hydroxylase) genotype, showing increased systemic exposure and less interindividual variability. Further, esomeprazole is a more potent acid inhibitor than other currently available PPIs and is therefore used as a first-line drug for acid-related diseases. While esomeprazole has been available in a number of countries worldwide, the compound only received authorized permission to be marketed in Japan in September 2011. The standard esomeprazole dose in Japan for the treatment of peptic ulcers and gastroesophageal reflux disease (GERD) is 20 mg. Other advised dosages are 10 mg for nonerosive reflux disease and 20 mg twice-daily dosing for eradication of Helicobacter pylori. In Japanese, the effective rate of esomeprazole 20 mg during 24 weeks for GERD patients is 92.0% (88.0%–96.0%), while the prevention of peptic ulcer development using 20 mg for 24 weeks in patients treated with nonsteroidal anti-inflammatory drugs is 96.0% (92.8%–99.1%). Although clinical data are limited, the usefulness of esomeprazole is expected in Japanese subjects given the reduced prevalence of CYP2C19 rapid metabolizers in Japan compared with Western countries.

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Section: H Pylori Eradication Therapy In Japanmentioning

confidence: 96%

Efficacy of esomeprazole in treating acid-related diseases in Japanese populations

Sugimoto¹,

Furuta²

2012

CEG

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“…It is known that the CYP2C19 isoenzyme exhibits genetic polymorphism, where approximately 3% of Caucasians and 15–20% of Asians are poor metabolizers. Because esomeprazole metabolism is affected to a much smaller extent, there is less inter-patient variability between poor and extensive metabolizers of CYP2C19 [4]. Thus, the greater and more consistent bioavailability of esomeprazole provides a rationale for its superior control of gastric acid secretion and improved clinical efficacy compared with omeprazole.…”

Section: Discussionmentioning

confidence: 99%

“…However, the results of our meta-analysis showed that the efficacy of esomeprazole and omeprazole with respect to H. pylori eradication were not different when combined with two antibiotics. A recent study showed that the high dose of esomeprazole (40 mg twice daily) in triple therapy may improve H. pylori eradication relative to omeprazole-based therapy, but only for homologous extensive metabolizers of CYP2C19 [4]. …”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis: Comparison of Esomeprazole and Other Proton Pump Inhibitors in Eradicating <i>Helicobacter pylori</i>

et al. 2006

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Background: To assess effects of esomeprazole-based therapies and others (PPIs) on Helicobacter pylori eradication when co-administered with antibiotics. Goals: Using the terms ‘H. pylori eradication’ and ‘esomeprazole’, we searched Medline, Embase, and the Cochrane Library (2000–2005) and conducted a manual search of related Chinese journals to identify randomized controlled trials (RCTs) that compared the treatment effects of esomeprazole and other PPI therapies in patients with H. pylori infection. Results: Of the 75 articles screened, 11 RCTs including 2,159 subjects were included in the meta-analysis. The mean H. pylori eradication rates (intention-to-treat, ITT) with esomeprazole + antibiotics was 86%, a rate comparable with other PPI therapies, 81% (ITT); the odds ratio (OR) was 1.38 (95% CI = 1.09–1.75). A focused meta-analysis of 6 selected high-quality studies was produced an OR of this comparison that was closer to one (1.17, 95% CI = 0.89–1.54), with the results being statistically homogeneous. Sub-analysis that included only studies comparing different does of esomeprazole with omeprazole or pantoprazole did not reveal significant differences. No additional serious adverse events were reported. Conclusions: Esomeprazole-based triple therapy may effectively eradicate H. pylori infection and promote favorable outcome with good tolerance and offers comparable efficacy to omeprazole-based therapy.

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“…According to our previous study, the eradication rate of standard triple therapy is 82% (27). It is estimated that we required Ն102 patients in each treatment group to demonstrate a 10% absolute difference in the eradication rate with a type I error of 0.05 and a type II error and power of 80%, assuming a 5% loss to follow-up.…”

Section: Methodsmentioning

confidence: 99%

Randomized Controlled Trial Comparing 7-Day Triple, 10-Day Sequential, and 7-Day Concomitant Therapies for Helicobacter pylori Infection

Hsu

Chen

et al. 2014

Antimicrob Agents Chemother

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e With the rising prevalence of antimicrobial resistance, the failure rate of the standard triple therapy for Helicobacter pylori infection is increasing. Sequential therapy and concomitant therapy have been recommended to replace standard triple therapy for H. pylori eradication in regions with high clarithromycin resistance. The aim of this prospective, randomized, and controlled study was to simultaneously assess the efficacies of 10-day sequential and 7-day concomitant therapies versus a 7-day standard triple therapy for treating H. pylori infection. Consecutive H. pylori-infected subjects were randomly assigned to a 7-day standard triple therapy (pantoprazole, clarithromycin, and amoxicillin for 7 days), a 10-day sequential therapy (pantoprazole and amoxicillin for 5 days, followed by pantoprazole, clarithromycin, and metronidazole for a further 5 days), or a 7-day quadruple therapy (pantoprazole, clarithromycin, amoxicillin, and metronidazole for 7 days). H. pylori status was confirmed 6 weeks after therapy. Three hundred seven H. pylori-infected participants were randomized to receive triple (n ‫؍‬ 103), sequential (n ‫؍‬ 102), or concomitant (n ‫؍‬ 102) therapies. The eradication rates by an intention-to-treat analysis in the three treatment groups were 81.6% (95% confidence interval [CI], 74.1% to 89.0%), 89.2% (95% CI, 83.2% to 95.2%), and 94.1% (95% CI, 89.5% to 98.7%). The seven-day concomitant therapy had a higher eradication rate than did the 7-day triple therapy (difference, 12.5%; 95% CI, 3.7% to 21.3%). There were no significant differences in the eradication rates between the sequential and standard triple therapies. All three treatments exhibited similar frequencies of adverse events (8.7%, 8.8%, and 13.7%, respectively) and drug compliance (99.0%, 98.0%, and 100.0%, respectively). In conclusion, the seven-day concomitant therapy is superior to the 7-day standard triple therapy for H. pylori eradication. Additionally, it is less complex than the 10-day sequential therapy because the drugs are not changed halfway through the treatment course. (This study has been registered at ClinicalTrials.gov under registration no. NCT1769365.)

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A Prospective Randomized Trial of Esomeprazole- versus Pantoprazole-Based Triple Therapy for Helicobacter pylori Eradication

Cited by 54 publications

References 25 publications

Efficacy of esomeprazole in treating acid-related diseases in Japanese populations

Efficacy of esomeprazole in treating acid-related diseases in Japanese populations

A Meta-Analysis: Comparison of Esomeprazole and Other Proton Pump Inhibitors in Eradicating <i>Helicobacter pylori</i>

Randomized Controlled Trial Comparing 7-Day Triple, 10-Day Sequential, and 7-Day Concomitant Therapies for Helicobacter pylori Infection

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