Efficacy of Seven-Day Potassium-Competitive Acid Blocker-Based First-Line Helicobacter Pylori Eradication Therapy Administered with Bismuth
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Purpose: To determine the efficacy of a potassium-competitive acid blocker (P-CAB)-based first-line eradication therapy with bismuthcompared with that of proton pump inhibitor-based first-line therapy with bismuth. Materials and Methods: Eradication-naive H. pylori-infected patients were consecutively enrolled from January to November2020. Before approval of the P-CAB-based eradication therapy, twice daily administration of a regimen containing lansoprazole30 mg, amoxicillin 1 g, clarithromycin 500 mg, and bismuth potassium citrate 300 mg was prescribed for 7 days. After approval,lansoprazole was replaced with tegoprazan (50 mg). Clarithromycin resistance was examined in patients who underwent gastroscopicbiopsy at our center. Efficacy was assessed via the 13C-urea breath test. Results: Of the 381 eradication-naive patients, eradication was successful in 88.3% (151/171) treated with tegoprazan and 82.8%(140/169) treated with lansoprazole in per-protocol analysis (p=0.151). In intention-to-treat analysis, eradication rates were 78.8%(152/193) in the tegoprazan and 74.5% (140/188) in the lansoprazole group (p=0.323). Clarithromycin resistance was observed in30 (20.1%) of the 148 patients (74 from each group), and only four of the 16 clarithromycin-resistant patients in the tegoprazangroup achieved successful eradication. Clarithromycin resistance [odds ratio (OR)=42.1, 95% confidence intervals (CIs)=12.6–141.0] and poor patient compliance (OR=17.1, 95% CIs=1.6–189.1) were independent risk factors for eradication failure. Conclusion: In eradication-naive patients, eradication success rates for 7-day first-line triple therapy regimen exceeded 82% withbismuth administration. In clarithromycin-resistant patients, neither tegoprazan 50 mg nor lansoprazole 30 mg achieved acceptableeradication rates when administered twice daily for 7 days.
Abstract
Purpose: To determine the efficacy of a potassium-competitive acid blocker (P-CAB)-based first-line eradication therapy with bismuthcompared with that of proton pump inhibitor-based first-line therapy with bismuth. Materials and Methods: Eradication-naive H. pylori-infected patients were consecutively enrolled from January to November2020. Before approval of the P-CAB-based eradication therapy, twice daily administration of a regimen containing lansoprazole30 mg, amoxicillin 1 g, clarithromycin 500 mg, and bismuth potassium citrate 300 mg was prescribed for 7 days. After approval,lansoprazole was replaced with tegoprazan (50 mg). Clarithromycin resistance was examined in patients who underwent gastroscopicbiopsy at our center. Efficacy was assessed via the 13C-urea breath test. Results: Of the 381 eradication-naive patients, eradication was successful in 88.3% (151/171) treated with tegoprazan and 82.8%(140/169) treated with lansoprazole in per-protocol analysis (p=0.151). In intention-to-treat analysis, eradication rates were 78.8%(152/193) in the tegoprazan and 74.5% (140/188) in the lansoprazole group (p=0.323). Clarithromycin resistance was observed in30 (20.1%) of the 148 patients (74 from each group), and only four of the 16 clarithromycin-resistant patients in the tegoprazangroup achieved successful eradication. Clarithromycin resistance [odds ratio (OR)=42.1, 95% confidence intervals (CIs)=12.6–141.0] and poor patient compliance (OR=17.1, 95% CIs=1.6–189.1) were independent risk factors for eradication failure. Conclusion: In eradication-naive patients, eradication success rates for 7-day first-line triple therapy regimen exceeded 82% withbismuth administration. In clarithromycin-resistant patients, neither tegoprazan 50 mg nor lansoprazole 30 mg achieved acceptableeradication rates when administered twice daily for 7 days.
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