Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole- or rabeprazole-based triple therapy in Japan

Authors

Miki Ikuya, Kobe University School of Medicine. Japan
Aoyama Nobuo, Kobe University School of Medicine.Japan
Sakai Toshiyuki, Kobe University School of Medicine.Japan
Shirasaka Daisuke, Kobe University School of Medicine. Japan
Casmir Wambura, Aga Khan UniversityFollow
Maekawa Shujia, Kobe University School of Medicine.Japan
Kuroda Kohei, Kobe University School of Medicine. Japan
Tamura Takao, Kobe University School of Medicine. Japan
Kita Tomoko, Kobe University School of Medicine,Japan
Sakaeda Toshiyuki, Kobe University School of Medicine. Japan
Katsuhiko Okumura, Kobe University School of Medicine, Japan
Kasuga Masato, Kobe University School of Medicine, Japan

Document Type

Article

Department

Internal Medicine (East Africa)

Abstract

Objective

Helicobacter pylori treatment failure is thought to be due mainly to polymorphic cytochrome P450 2C19 (CYP2C19) genetic polymorphism, associated with proton pump inhibitor metabolism, and antimicrobial susceptibility. This report has ascertained which was more important, CYP2C19 polymorphism or antimicrobial susceptibility, when using 1-week lansoprazole-based or rabeprazole-based triple therapy in Japan.

Design

An open, randomized, parallel group study.

Setting

One hundred and forty-five subjects with H. pylori-positive gastritis or peptic ulcers were randomly assigned to receive 30 mg lansoprazole twice daily (LAC group), 10 mg rabeprazole twice daily (RAC20 group), or 20 mg rabeprazole twice daily (RAC40 group), with 1000 mg amoxicillin twice daily and 400 mg clarithromycin twice daily for 1 week. Antimicrobial resistance testing was performed by E-test. More than 4 weeks after completion of treatment, H. pylori status was assessed by ¹³C-urea breath test, histology, and culture.

Results

Cure rates expressed as intention-to-treat and per-protocol analyses, respectively, were 79.6 and 83.0% with LAC, 85.4 and 89.1% with RAC20, and 83.3 and 88.9% with RAC40. In the case of clarithromycin-sensitive strains, the cure rates were more than 97%, regardless of CYP2C19 polymorphism. However, treatment succeeded in only one out of 16 clarithromycin-resistant strains.

Conclusions

The key to successful eradication of H. pylori, using lansoprazole or rabeprazole with clarithromycin and amoxicillin, is clarithromycin susceptibility, not CYP2C19 polymorphism.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

European Journal of Gastroenterology & Hepatology

Recommended Citation

Miki, I., Aoyama, N., Sakai, T., Shirasaka, D., Wambura, C. M., Maekawa, S., ... & Kasuga, M. (2003). Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole-or rabeprazole-based triple therapy in Japan. European journal of gastroenterology & hepatology, 15(1), 27-33.