Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication of Helicobacter pylori

Shinya Yamada, Takumi Kawakami, Yoshikazu Nakatsugawa, Takahiro Suzuki, Hideki Fujii, Naoya Tomatsuri, Hideki Nakamura, Hideki Sato, Yusuke Okuyama, Hiroyuki Kimura, Norimasa Yoshida, Shinya Yamada, Takumi Kawakami, Yoshikazu Nakatsugawa, Takahiro Suzuki, Hideki Fujii, Naoya Tomatsuri, Hideki Nakamura, Hideki Sato, Yusuke Okuyama, Hiroyuki Kimura, Norimasa Yoshida

Abstract

Aim: To investigate usefulness of triple therapy with vonoprazan, a potassium ion-competitive acid blocker and antibiotics, for Helicobacter pylori (H. pylori) eradication.

Methods: The H. pylori eradication rate was examined in 2507 patients (2055 undergoing primary eradication and 452 undergoing secondary eradication, excluding patients with subtotal gastrectomy) at the Japanese Red Cross Kyoto Daiichi Hospital from March 2013 to September 2015. For patients treated from March 2013 to February 2015, a proton pump inhibitor (PPI) was used to reduce acid secretion, while vonoprazan was used after March 2015. The success rates of the 2 regimens (PPI + amoxicillin + clarithromycin/metronidazole, or vonoprazan + amoxicillin + clarithromycin/metronidazole) were compared.

Results: The success rate of primary H. pylori eradication was significantly higher in the vonoprazan group. When stratified by the underlying disease, a significant increase of the H. pylori eradication rate was observed in patients with chronic gastritis. A significantly lower H. pylori eradication rate was observed in younger patients compared to older patients in the PPI group, but there was no difference according to age in the vonoprazan group. On the other hand, the success rate of secondary eradication was similar at approximately 90% in both groups.

Conclusion: Vonoprazan is very useful for primary eradication of H. pylori, and may become a first-line acid secretion inhibitor instead of PPIs.

Keywords: Chronic gastritis; Eradication; Helicobacter pylori; Potassium ion-competitive acid blocker; Vonoprazan.

Conflict of interest statement

Conflict-of-interest statement: There is no conflict of interest.

References

    1. Herrero R, Park JY, Forman D. The fight against gastric cancer - the IARC Working Group report. Best Pract Res Clin Gastroenterol. 2014;28:1107–1114.
    1. Kobayashi I, Murakami K, Kato M, Kato S, Azuma T, Takahashi S, Uemura N, Katsuyama T, Fukuda Y, Haruma K, et al. Changing antimicrobial susceptibility epidemiology of Helicobacter pylori strains in Japan between 2002 and 2005. J Clin Microbiol. 2007;45:4006–4010.
    1. Nagahara A, Miwa H, Ohkura R, Yamada T, Sato K, Hojo M, Sato N. Strategy for retreatment of therapeutic failure of eradication of Helicobacter pylori infection. J Gastroenterol Hepatol. 2001;16:613–618.
    1. Isomoto H, Inoue K, Furusu H, Enjoji A, Fujimoto C, Yamakawa M, Hirakata Y, Omagari K, Mizuta Y, Murase K, et al. High-dose rabeprazole-amoxicillin versus rabeprazole-amoxicillin-metronidazole as second-line treatment after failure of the Japanese standard regimen for Helicobacter pylori infection. Aliment Pharmacol Ther. 2003;18:101–107.
    1. Murakami K, Sato R, Okimoto T, Nasu M, Fujioka T, Kodama M, Kagawa J. Efficacy of triple therapy comprising rabeprazole, amoxicillin and metronidazole for second-line Helicobacter pylori eradication in Japan, and the influence of metronidazole resistance. Aliment Pharmacol Ther. 2003;17:119–123.
    1. Miwa H, Nagahara A, Kurosawa A, Ohkusa T, Ohkura R, Hojo M, Enomoto N, Sato N. Is antimicrobial susceptibility testing necessary before second-line treatment for Helicobacter pylori infection? Aliment Pharmacol Ther. 2003;17:1545–1551.
    1. Shimoyama T, Fukuda S, Mikami T, Fukushi M, Munakata A. Efficacy of metronidazole for the treatment of clarithromycin-resistant Helicobacter pylori infection in a Japanese population. J Gastroenterol. 2004;39:927–930.
    1. Beard CM, Noller KL, O’Fallon WM, Kurland LT, Dahlin DC. Cancer after exposure to metronidazole. Mayo Clin Proc. 1988;63:147–153.
    1. Hori Y, Imanishi A, Matsukawa J, Tsukimi Y, Nishida H, Arikawa Y, Hirase K, Kajino M, Inatomi N. 1-[5-(2-Fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate (TAK-438), a novel and potent potassium-competitive acid blocker for the treatment of acid-related diseases. J Pharmacol Exp Ther. 2010;335:231–238.
    1. Jenkins H, Sakurai Y, Nishimura A, Okamoto H, Hibberd M, Jenkins R, Yoneyama T, Ashida K, Ogama Y, Warrington S. Randomised clinical trial: safety, tolerability, pharmacokinetics and pharmacodynamics of repeated doses of TAK-438 (vonoprazan), a novel potassium-competitive acid blocker, in healthy male subjects. Aliment Pharmacol Ther. 2015;41:636–648.
    1. Sakurai Y, Mori Y, Okamoto H, Nishimura A, Komura E, Araki T, Shiramoto M. Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects--a randomised open-label cross-over study. Aliment Pharmacol Ther. 2015;42:719–730.
    1. Cederbrant G, Kahlmeter G, Schalén C, Kamme C. Additive effect of clarithromycin combined with 14-hydroxy clarithromycin, erythromycin, amoxycillin, metronidazole or omeprazole against Helicobacter pylori. J Antimicrob Chemother. 1994;34:1025–1029.
    1. The interview form for vonoprazan fumarate (Takecab® tablets 10 mg and 20 mg) ver 6, (in Japanese). Takeda Pharmaceutical Company Limited. 2015. Available from:
    1. Rodrigues AD, Roberts EM, Mulford DJ, Yao Y, Ouellet D. Oxidative metabolism of clarithromycin in the presence of human liver microsomes. Major role for the cytochrome P4503A (CYP3A) subfamily. Drug Metab Dispos. 1997;25:623–630.
    1. Sugimoto M, Uotani T, Sahara S, Ichikawa H, Yamade M, Sugimoto K, Furuta T. Efficacy of tailored Helicobacter pylori eradication treatment based on clarithromycin susceptibility and maintenance of acid secretion. Helicobacter. 2014;19:312–318.
    1. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut. 2016;65:1439–1446.
    1. Suzuki S, Gotoda T, Kusano C, Iwatsuka K, Moriyama M. The Efficacy and Tolerability of a Triple Therapy Containing a Potassium-Competitive Acid Blocker Compared With a 7-Day PPI-Based Low-Dose Clarithromycin Triple Therapy. Am J Gastroenterol. 2016;111:949–956.

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