Gastro Hep Advances (Jan 2022)
Two-dimension Tailor-made Therapy: A New Salvage Therapy After Multiple Eradication Failures for Helicobacter pylori Infection
Abstract
Background and Aims: Vonoprazan-based eradication therapies have a 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 antibiotic susceptibility tests (ASTs). PPI doses per day were decided as per the CYP2C19 genotype: twice for poor and 4 times for extensive metabolizers (dimension 1). Two antibiotics were selected as per the results of the 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 the AST, tailor-made PPI dosing was indicated with empirically selected 2 antibiotics (one-dimension tailor-made therapy [1dTMT]). Results: Of 51 candidates with multiple eradication failures, 37 patients underwent the genotype test and AST, and 24 succeeded to obtain sufficient information to select 2 susceptible antibiotics. Of them, 22 patients accepted to receive 14-day 2dTMT. Of the residual patients, 12 accepted to receive 14-day 1dTMT. The mean eradication rate of 2dTMT was 86.4% (95% confidence interval [CI]: 65.1%–98.8%) in intention-to-treat and 90.5% (95% CI: 69.6%–98.8%) in per-protocol analyses, whereas that of 1dTMT was 75.0% (95% CI: 42.8%–94.5%) in intention-to-treat and 90.0% (95% CI: 55.5%–99.7%) in per-protocol 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 the AST, 14-day 1dTMT could be an alternative therapy. Clinical Trials Registry number, UMIN000022154 (https://www.umin.ac.jp/icdr/index.html).
