Rabeprazole‐based 3‐day and 7‐day triple therapy vs. omeprazole‐based 7‐day triple therapy for the treatment of Helicobacter pylori infection

Abstract

INTRODUCTIONIn the Asia-Paci®c consensus conference on the management of Helicobacter pylori infection, the recommended regimens included the use of a proton pump inhibitor at a standard dose, plus two antibiotics (clarithromycin, amoxicillin or metronidazole), each given twice daily for 7 days. This regimen should attain a per protocol eradication rate of at least 90%, or an intention-to-treat eradication rate of at least 80%. 1 The high eradication rates of these combinations have been con®rmed in Western countries. 2,3 In the MACH 1 study, the regimen using omeprazole plus amoxicillin, 1000 mg, and clarithromycin, 500 mg (OAC), all given twice daily, was one of the most effective regimens, with an intention-to-treat eradication rate of 91%. 2 The high ef®cacy of this lowdose clarithromycin regimen was con®rmed by the SUMMARY Background: Rabeprazole is a new proton pump inhibitor with more potent acid suppressive and antiHelicobacter effects. Aim: To compare two different regimens of rabeprazolebased triple therapy vs. 7-day omeprazole-based triple therapy for the eradication of Helicobacter pylori infection. Method: Patients with proven H. pylori infection were randomized to receive: (i) 7-day rabeprazole, 10 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily; (ii) 3-day rabeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily; or (iii) 7-day omeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily. Endoscopy (CLO test, histology) was performed before randomization and 6 weeks after drug treatment.

How Can the Current Strategies for Helicobacter pylori Eradication Therapy be Improved?

“…However, five RCTs (16,(21)(22)(23)(24) evaluating 934 patients were found that compared the equivalent doses of rabeprazole and omeprazole in PAC regimens. Meta-analysis of these trials suggests that rabeprazole is superior to omeprazole (RRR 8%, 95% CI 2% to 14%; NNT 16, 95% CI 9 to 65) ( Figure 3).…”

“…Indeed, American guidelines recommend 10 days of therapy, while European guidelines suggest that seven days is sufficient {1,48}. Shortening the duration of triple therapy to less than seven days has been shown to have a deleterious effect on eradication rates (23,48).…”

Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?

“…A significant reduction of adverse effects was observed with the use of a shorter (n=338) Excluded (n=248) because: 233 titles not appropriate; 9 articles in Spanish, German, and Japanese; 3 commences, letters; 3 studies on children Abstracts retrieved (n=90) Excluded (n=70) P<0.001), the day number with side-effects was reduced by an average of 3.5 d per patient in this study protocol in studies conducted by Wong et al (2001b). It was reported that the mean duration of all adverse effects was significantly shorter in the 3-d RAC (rabeprazole, amoxicillin, and clarithromycin) group when compared to the 7-d RAC group (2.8 d vs. 6.0 d, P<0.001) (Wong et al, 2001a).…”

“…They came from studies conducted in eight regions from six countries (Table 1). To make paired comparison convenient, one matched study arm was omitted from Wong et al (2001a) 's, Pieramico et al (1998) 's, and Yang et al (2003)'s trials, respectively.…”

One-year follow-up study ofHelicobacter pylorieradication rate with13C-urea breath test after 3-d and 7-d rabeprazole-based triple therapy

“…The trial results showed that 7-d therapy with rabeprazole-clarithromycin-amoxicillin is similar in efficacy to 10-d therapies and had similar efficacy in patients with and without ulcer disease. Wong et al [29] performed a randomized study to compare rabeprazole-amoxicillinclarithromycin administration for 3 and 7 d. They found 3-d regimen had a lower H pylori eradication rate than 7-d regimen (72% vs 88%, ITT; 72% vs 91%, PP). Hence, they concluded 7-d rabeprazole-based triple therapy is superior to 3-d regimen (P = 0.04).…”