The multicenter real-world report of the efficacies of 14-day esomeprazole-based and rabeprazole-based high-dose dual therapy in first-line Helicobacter pylori eradication in Taiwan

Wei-Chen Tai; I-Ting Wu; Hsin-Ming Wang; Pao-Yuan Huang; Chih-Chien Yao; Cheng-Kun Wu; Shih-Cheng Yang; Chih-Ming Liang; Pin-I Hsu; Seng-Kee Chuah

doi:10.1016/j.jmii.2024.02.009

The multicenter real-world report of the efficacies of 14-day esomeprazole-based and rabeprazole-based high-dose dual therapy in first-line Helicobacter pylori eradication in Taiwan

J Microbiol Immunol Infect. 2024 Mar 4:S1684-1182(24)00046-X. doi: 10.1016/j.jmii.2024.02.009. Online ahead of print.

Authors

Affiliations

¹ Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan.
² Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan.
³ Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
⁴ Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan. Electronic address: ilessalen@gmail.com.

PMID: 38461114
DOI: 10.1016/j.jmii.2024.02.009

Abstract

Background: High-dose dual therapy (HDDT) using proton-pump inhibitors (PPI) and amoxicillin attracted attention for its simplicity and lower adverse event profile. Besides, vonoprazan is not available worldwide. This real-world study aims to compare the efficacy of esomeprazole-based and rabeprazole-based HDDT regimens and to identify clinical factors influencing outcomes.

Methods: A retrospective study enrolled 346 Helicobacter pylori-infected naïve patients from January 2016 to August 2023. Patients were assigned to either a 14-day esomeprazole-based HDDT (EA-14; esomeprazole 40 mg t.i.d. and amoxicillin 750 mg q.i.d. for 14 days, n = 173) or a 14-day rabeprazole-based HDDT (RA-14; rabeprazole 20 mg and amoxicillin 750 mg q.i.d. for 14 days, n = 173).

Results: Five patients from the EA-14 group and 10 from the RA-14 group were lost to follow-up, resulting in 168 and 163 patients for the per-protocol (PP) analysis, respectively. Eradication rates for the EA-14 and RA-14 groups were 90.2% and 80.9% (P = 0.014) in intention-to-treat (ITT) analysis; and 92.9% and 85.9% (P = 0.039) in PP analysis. Adverse event rates were similar between the two groups (11.9% vs 11.7%, P = 0.944). In multiple logistic regression analysis, age≧60 was associated with eradication failure (P = 0.046) and a trend of significance for smoking (P = 0.060) in the EA-14 group but not in the RA-14 group. A trend of significance was also observed for eradication regimens (EA-14 vs RA-14) (P = 0.071). The antibiotic resistance rates were amoxicillin (2.3%), clarithromycin (14.7%), metronidazole (40.3%), and dual resistance to clarithromycin and metronidazole (7.0%).

Conclusions: Esomeprazole-based HDDT achieved over 90% eradication rates but rabeprazole-based HDDT, which failed.

Keywords: Antibiotic susceptibility; Esomeprazole; Helicobacter pylori infection; High dose dual therapy; Rabeprazole.