<p>A comparison between dexlansoprazole modified release–based and lansoprazole-based nonbismuth quadruple (concomitant) therapy for first-line <em>Helicobacter pylori</em> eradication: a prospective randomized trial</p>

Abstract

PurposeSteadily maintaining high intra-gastric PH is the major factor for successful Helicobacter pylori (H.pylori) eradication. It is important to search for a stronger PPI. Dexlansoprazole MR is a dual delayed release formulation PPI taken once daily which is capable of maintaining longer duration of high intra-gastric PH. It is very effective in treating gastroesophageal disease but reports on H, pylori eradication is very rare. This study sought to compare dexlansoprazole MR-based concomitant treatment and lansoprazole-based concomitant treatment in H. pylori infection and to investigate the factors that affect the eradication rates.MethodsTwo hundred two participants with H. pylori infection were included and randomly assigned to seven days of dexlansoprazole MR-based concomitant therapy (dexlansoprazole MR 60 mg once daily, clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily and metronidazole 500 mg twice daily; DACM group) or a seven days of lansoprazole-based concomitant therapy (lansoprazole 30 mg twice daily, clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily, and metronidazole 500 mg twice daily; LACM group). The participants were asked to perform urea breath tests eight weeks later.ResultsThe eradication rates in the DACM group were 86.1% [95% confidence interval (CI): 77.8%–92.2%] in the ITT analysis and 90.6% (95% CI: 82.9%–95.6%) in the PP analysis, respectively, as compared with 90.1% (95% CI: 82.6%–95.2%) and 92.6% (95% CI: 85.5%–96.9%) (p=0.384 and p=0.572, respectively) in the LACM group for the same analyses. The adverse event rates were 11.5% in the DACM group and 10.2% in the LACM group (p=0.779).ConclusionAs a first-line H. pylori treatment regimen, dexlansoprazole MR-based concomitant therapy attained a successful eradication rate of 90%, which was non inferior to that of lansoprazole-based concomitant treatment.ClinicalTrials.gov identifierNCT03829150.

The efficacies of non-bismuth containing quadruple therapies in the treatment of first-line anti-Helicobacter pylori across 4-year time interval with changing antibiotics resistance

“…Nevertheless, there were more and more reports on the drops of standard triple therapies in Taiwan because of the increase of clarithromycin resistance in Taiwan [ 6 , 11 , 14 , 15 , 18 ]. Concomitant therapy was one of the treatment options recommended which was superior to clarithromycin-triple therapy of the same duration for the eradication of H. pylori and has been recommended as the first line therapy in areas of high (>15%) clarithromycin resistance [ 1 , 24 ].…”

“…The urea breath test was also performed according to our previous studies with the cut-off value was set at 4.8% of d13CO2 [ 8 , 11 , 13 ].…”

“…Fortunately, many alternative therapies are available which provide eradication rates of over or near 90%, including non-bismuth containing quadruple therapy (concomitant therapy), high dose dual therapy, and hybrid or reverse hybrid therapy [ 8 , [11] , [12] , [13] , [14] , [15] , [16] ]. The success rate of concomitant therapy was much better than standard triple therapy but was affected by the dual clarithromycin and metronidazole resistances [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ].…”

“…Fortunately, many alternative therapies are available which provide eradication rates of over or near 90%, including non-bismuth containing quadruple therapy (concomitant therapy), high dose dual therapy, and hybrid or reverse hybrid therapy [ 8 , [11] , [12] , [13] , [14] , [15] , [16] ]. The success rate of concomitant therapy was much better than standard triple therapy but was affected by the dual clarithromycin and metronidazole resistances [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. The reported primary resistance rates of clarithromycin and metronidazole in Taiwan up to 2012 were 11.2% and 25.7% respectively, and dual clarithromycin and metronidazole resistance was 4.3%, but also with considerable variation among different districts reported [ 18 , 19 ].…”

Newer, Older, and Alternative Agents for the Eradication of Helicobacter pylori Infection: A Narrative Review

“…A head-to-head comparison with ESO in triple and quadruple regimens revealed acceptable rates of eradication. Although DL is one of the most popular PPIs prescribed in the United States, most studies have been performed in the Far Eastern countries [ 18 , 19 , 20 , 21 ] ( Table 1 ).…”