Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection and CYP2C19 genetic polymorphism

Abstract

Background: Rabeprazole is a new, potent, proton pump inhibitor. The metabolism of rabeprazole is less dependent on CYP2C19 genetic polymorphism. Methods: A total of 102 Helicobacter pylori‐positive patients with gastric ulcer were randomly allocated to three groups: rabeprazole 10 mg (RAC10), rabeprazole 20 mg (RAC20) or rabeprazole 40 mg (RAC40) plus amoxicillin 750 mg and clarithromycin 200 mg twice daily for 7 days. CYP2C19 genotype was determined by the polymerase chain reaction‐restriction fragment length polymorphism method. Results: All‐patients‐treated‐based eradication rates in patients treated with RAC10, RAC20 and RAC40 were 83%, 77% and 90%, respectively, and per protocol‐based eradication rates were 83%, 80% and 90%, respectively. The eradication rates in the three groups were not significantly different. There was also no significant difference between the all‐patients‐treated‐based eradication rate in CYP2C19 extensive metabolizers and that in poor metabolizers (86% vs. 77%). Adverse events were 12% in extensive metabolizers and 23% in poor metabolizers, and the difference in these incidence rates was also not statistically significant. Conclusions: Triple therapy with 10 mg of rabeprazole combined with amoxicillin/clarithromycin is effective for Japanese patients with H. pylori infection, and the H. pylori eradication rate is not affected by CYP2C19 genetic polymorphism.

Helicobacter pylorieradication in West Asia: A review

“…Most PPIs are metabolized by cytochrome P450 in the liver. Therefore, extensive metabolizer patients do not attain sufficient PPI levels to achieve optimal pH level for antibiotic effects [89] .…”

The Effectiveness of Packaged Medicine in Eradication Therapy of Helicobacter pylori in Japan

“…The eradication rate obtained by the triple therapy consisted of proton pump inhibitor (PPI) + amoxicillin (AMPC) + clarithromycin (CAM) [PPI /AC] was about 90% in 2000 [6], but it has slightly decreased in recent years [7]. As factors in outcome of eradication therapy, age, smoking cigarettes, compliance, drug sensitivity, and genetic polymorphism of CYP2C19 have been reported, but drug resistance to CAM has been reported to be most closely involved [8][9][10][11][12][13][14][15]. However, the compliance was more than 90% in these studies because the studies were clinical trials.…”

Resistance to Antimicrobialagents in Eradication of Helicobacter Pylori Infection

“…Many studies have reported that there are no significant differences in the rate of eradication when any of the 3 agents, omeprazole (OPZ), lansoprazole (LPZ), and rabeprazole (RPZ), ANNALS OF Cancer Research and Therapy is used as a PPI (Miwa, Ohkura et al, 1999;Inaba, Mizuno et al,2002) however, reported that RPZ achieved a higher rate of eradication than LPZ. In addition, several studies have indicated that there are no significant differences in the rate of eradication among different doses of RPZ as a PPI, 10mg, 20mg, and 40mg (Hokari, Sugiyama et al, 2001;Miwa, Yamada et al, 2000). Similarly, there were no significant differences in the rate of eradication between 2 doses of CAM: 400mg and 800mg Hokari, Sugiyama et al, 2001;Kihira, Satoh et al, 2000).…”

“…In addition, several studies have indicated that there are no significant differences in the rate of eradication among different doses of RPZ as a PPI, 10mg, 20mg, and 40mg (Hokari, Sugiyama et al, 2001;Miwa, Yamada et al, 2000). Similarly, there were no significant differences in the rate of eradication between 2 doses of CAM: 400mg and 800mg Hokari, Sugiyama et al, 2001;Kihira, Satoh et al, 2000).…”

“…It has been reported that factors involved in failure in eradication by PPI/AC therapy include compliance, age, smoking, CYP2C19 gene polymorphism, resistance to antimicrobial agents, and values of urea breath test before the treatment (Hokari, Sugiyama et al, 2001;Perri, Villani et al, 2001;Kamada, Haruma et al, 1999;Furuta, Naohito et al, 2001;Poon, Chang et al, 2002). Miiwa, Misawa et al, (2001) indicated that among theses factors, CAM resistance most markedly influenced success in eradication.…”