- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03555526
Genotypic Resistance Guided Therapy for Refractory H. Pylori Infection
Comparison of Genotypic Resistance Guided Versus Susceptibility Testing Guided Therapy for the Third-line Eradication of H. Pylori- a Multicenter Randomized Trial
The inviestigators aimed to compare the efficacy of genotypic resistance guided versus susceptibility testing guided therapy in the third line treatment for refractory H. pylori infection.
Hypothesis:The investigators hypothesized that genotypic resistance guided sequential therapy is non-inferior to empiric therapy in the third line treatment for refractory H. pylori infection.
Methods: This multicenter, open label, parallel group, randomized trial will be conducted since 2017.07.20. Adult (≥20 years old) patients who failed from at least two eradication therapies for H. pylori infection will be enrolled. Genotypic and phenotypic resistances will be determined in patients who failed from at least two eradication therapies by polymerase-chain-reaction with direct sequencing and E-test and agar dilution test, respectively. Eligible patients will be randomized into either one of the treatment groups (A) genotypic resistance guided therapy; or (B) susceptibility testing guided therapy.
Outcome Measurement The primary outcome is the eradication rate in the third line treatment (genotypic versus susceptibility testing guided therapy) according to intention-to-treat (ITT) analysis.
Study Overview
Status
Conditions
Detailed Description
The inviestigators aimed to compare the efficacy of genotypic resistance guided versus susceptibility testing guided therapy in the third line treatment for refractory H. pylori infection.
Hypothesis:The investigators hypothesized that genotypic resistance guided sequential therapy is non-inferior to empiric therapy in the third line treatment for refractory H. pylori infection.
Methods: This multicenter, open label, parallel group, randomized trial will be conducted since 2017.07.20. Adult (≥20 years old) patients who failed from at least two eradication therapies for H. pylori infection will be enrolled. Genotypic and phenotypic resistances will be determined in patients who failed from at least two eradication therapies by polymerase-chain-reaction with direct sequencing and E-test and agar dilution test, respectively. Eligible patients will be randomized into either one of the treatment groups (A) genotypic resistance guided therapy; or (B) susceptibility testing guided therapy. Eradication status will be determined by 13C-urea breath test at least 6 weeks after eradication therapy. The stool samples will be collected before, and 2 and 8 weeks and 1 year after eradication therapy to analyze the changes in the antibiotic resistance and microbiota of gut flora. The body weight, waist and hip circumference and serum lipid profile, sugar, and HbA1C levels will also be collected before and 2 weeks, 8 weeks and 1 year after eradication therapy.
Outcome Measurement The primary outcome is the eradication rate in the third line treatment (genotypic versus susceptibility testing guided therapy) according to intention-to-treat (ITT) analysis.
Secondary End Points: the eradication rate according per protocol analysis and the adverse effects
Secondary End Point:
(A) Eradication rate according to per protocol analysis (PP analysis) (B) Frequency of adverse effects (C) The changes in the gut microbiota, antibiotic resistance of the Enterobacteriae, metabolic parameters before and after H. pylori eradication (D) The long term eradication rate and reinfection rate
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Jyh-Ming Liou, MD, PhD
- Phone Number: 886972651883
- Email: jyhmingliou@gmail.com
Study Contact Backup
- Name: Mei-Jyh Chen, MD
- Phone Number: 63541 886223123456
- Email: migichen@ntuh.gov.tw
Study Locations
-
-
Taiwan-
-
Taipei, Taiwan, Taiwan-, Taiwan, 10002
- Recruiting
- Jyh-Ming Liou
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- H pylori infection failed after at least two eradication therapies
- aged 20 years or greater
- willingness to receive rescue therapy
Exclusion Criteria:
- aged less than 20 years
- history of gastric resection surgery
- history of allergy to study drugs
- pregnancy or lactating women
- severe underlying illness, such as end stage renal disease, decompensated liver cirrhosis, or non-curative malignancy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Genotypic resistance guided therapy
The regimen will be chosen according to the genotyping of 23S rRNA and gyrase A of H. pylori.
In the absence of gyrase A mutation, esomeprazole (Nexium), amoxicillin (Amoxicillin), levofloxacin (Cravit), metronidazole (Flagyl) for 14 days will be given.
In the presence of gyrase A mutation but in the absence of 23S rRNA mutation, esomeprazole (Nexium), amoxicillin (Amoxicillin), clarithromycin (Klaricid), metronidazole (Flagyl) for 14 days will be given.
In the presence of both gyrase A and 23S rRNA mutation, bismuth quadruple therapy including esomeprazole (Nexium), bismuth (KCB), tetracycline, and metronidazole (Flagyl) for 10 days will be given.
|
Nexium (esomeprazole), 40mg, bid, for 14 days
Other Names:
amoxicillin, 1000mg, bid, for 7 days (day 1-day 7)
Other Names:
metronidazole, 500mg, bid, for 7 days (day 8-14)
Other Names:
levofloxacin 250mg, bid, for 7 days (day 8-14)
Other Names:
clarithromycin 500mg, bid, for 7 days (day 8-14)
Other Names:
Nexium (esomeprazole), 40mg, bid, for 10 days
Other Names:
Dibismuth trioxide,KCB F.C. TABLETS,300mg,qid, for 10 days
Other Names:
metronidazole, 500mg, tid, for 10 days (day 1-10)
Other Names:
tetracycline 500mg, qid, for 10 days
Other Names:
|
Active Comparator: Phenotypic resistance guided therapy
The regimen will be chosen according to the susceptibility testing result.
In the absence of levofloxacin resistance, esomeprazole (Nexium), amoxicillin (Amoxicillin), levofloxacin (Cravit), metronidazole (Flagyl) for 14 days will be given.
In the presence of levofloxacin resistance but in the absence of clarithromycin resistance, esomeprazole (Nexium), amoxicillin (Amoxicillin), clarithromycin (Klaricid), metronidazole (Flagyl) for 14 days will be given.
In the presence of both levofloxacin and clarithromycin resistance, bismuth quadruple therapy including esomeprazole (Nexium), bismuth (KCB), tetracycline, and metronidazole (Flagyl) for 10 days will be given.
|
Nexium (esomeprazole), 40mg, bid, for 14 days
Other Names:
amoxicillin, 1000mg, bid, for 7 days (day 1-day 7)
Other Names:
metronidazole, 500mg, bid, for 7 days (day 8-14)
Other Names:
levofloxacin 250mg, bid, for 7 days (day 8-14)
Other Names:
clarithromycin 500mg, bid, for 7 days (day 8-14)
Other Names:
Nexium (esomeprazole), 40mg, bid, for 10 days
Other Names:
Dibismuth trioxide,KCB F.C. TABLETS,300mg,qid, for 10 days
Other Names:
metronidazole, 500mg, tid, for 10 days (day 1-10)
Other Names:
tetracycline 500mg, qid, for 10 days
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Eradication rate by intention to treat analysis
Time Frame: 8 weeks
|
8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Eradication rate by per protocol analysis
Time Frame: 8 weeks
|
8 weeks
|
|
frequency of adverse effects during eradication therapy
Time Frame: 2 weeks
|
2 weeks
|
|
changes of fecal microbiota
Time Frame: 1 year
|
changes of fecal microbiota before and after erdication therapy
|
1 year
|
reinfection rate
Time Frame: 1 year
|
reinfection rate 1 year after eradication therapy
|
1 year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jyh-Ming Liou, MD, PhD, National Taiwan University Hospital (recruiting)
- Principal Investigator: Yen-Nien Chen, MD, National Taiwan University Hospital Hsin-Chu Branch
- Principal Investigator: Yu Jen Fang, MD, National Taiwan University Hospital, Yun-Lin Branch
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Infections
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antineoplastic Agents
- Gastrointestinal Agents
- Topoisomerase II Inhibitors
- Topoisomerase Inhibitors
- Anti-Bacterial Agents
- Cytochrome P-450 CYP3A Inhibitors
- Cytochrome P-450 Enzyme Inhibitors
- Protein Synthesis Inhibitors
- Antiprotozoal Agents
- Antiparasitic Agents
- Anti-Ulcer Agents
- Proton Pump Inhibitors
- Cytochrome P-450 CYP1A2 Inhibitors
- Antacids
- Anti-Infective Agents, Urinary
- Renal Agents
- Metronidazole
- Amoxicillin
- Clarithromycin
- Levofloxacin
- Ofloxacin
- Esomeprazole
- Bismuth
- Tetracycline
Other Study ID Numbers
- 201706037MINC
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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