| Autor: |
Yoshihide Fujiyama, Keiko Takahashi, Mariko Ohara, Makoto Fujii, Yuki Tsubakimoto, Hiroshi Hasegawa, Shigemi Nakajima, Hiroshi Satake, Hisayuki Inoue, Kiyoyuki Hayafuji, Rena Chatani |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
Gastro Hep Advances. 1:210-222 |
| ISSN: |
2772-5723 |
| DOI: |
10.1016/j.gastha.2021.11.006 |
| Popis: |
Background and Aims Vonoprazan-based eradication therapies have higher eradication rate than usual proton pump inhibitor (PPI)-based therapies in treating Helicobacter pylori infection. Should we use vonoprazan to treat patients who failed multiple eradication therapies? Because the drug is not available in most countries, we propose 2-dimension tailor-made therapy (2dTMT) without using vonoprazan. Methods Patients who failed twice or more PPI-based triple therapies were recruited. Patients underwent CYP2C19 genotype and antibiotics susceptibility tests (AST). PPI doses per day were decided according to the CYP2C19 genotype: twice for poor and four times for extensive metabolizers (dimension 1). Two antibiotics were selected according to the results of AST in each patient (dimension 2). Regimens of 2dTMT included 2 susceptible antibiotics and a PPI. For those who could not have enough information with AST, tailor-made PPI dosing was indicated with empirically selected two antibiotics (1dTMT). Results Of 51 candidates with multiple eradication failures, 37 patients underwent genotype test and AST, and 24 succeeded to obtain sufficient information to select two susceptible antibiotics. Of them, 22 patients accepted to receive 14-day 2dTMT. Of the residual patients, 12 accepted to receive 14-day 1dTMT. Mean eradication rate of 2dTMT was 86.4% (95%CI: 65.1-98.8%) in ITT and 90.5% (95%CI: 69.6-98.8%) in PP analyses. Whereas that of 1dTMT was 75.0% (95%CI: 42.8-94.5%) in ITT and 90.0% (95%CI: 55.5-99.7%) in PP analyses. Conclusion Without vonoprazan, 14-day 2dTMT could be one of the salvage therapies for patients with multiple eradication failures. In cases of insufficient information with AST, 14-day 1dTMT could be an alternative therapy. Clinical Trials Registry number, UMIN000022154 (https://www.umin.ac.jp/icdr/index.html). |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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