Efficacies of Hybrid and High-dose Dual Therapies for the First-line Anti-H Pylori Treatment

NCT ID: NCT05152004

Last Updated: 2022-07-20

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 240 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-01
• Study Completion Date: 2022-02-28

Brief Summary

Both hybrid and high-dose dual therapies developed by the scholars from Taiwan can achieve a high eradication rate for clarithromycin-resistant strains, and have a great potential to replace bismuth quadruple therapy in the treatment of H. pylori infection. This study aims to better understand the potential of both hybrid and igh-dose dual therapies in the treatment of H. pylori infection.

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Detailed Description

Helicobacter pylori (H. pylori) infect more than 50% of humans globally. It is the principal cause of chronic gastritis, gastric ulcer, duodenal ulcer, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma (MALToma). The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in H. pylori Eradication (REAP-HP) Survey demonstrated that standard triple therapy was still the most commonly used anti-H. pylori regimen in the Asia Pacific region. However, the eradication rates of standard triple therapy have declined to less than 80% in most countries worldwide. The main reasons for eradication failure of standard triple therapy include antibiotic resistance, poor compliance and CYP2C19 genotype of host. Clarithromycin resistance of H. pylori has been identified as the main reason for the failure of standard triple therapy. Pooled data from 20 studies involving 1,975 patients treated with standard triple therapy showed an eradication rate of 88% in clarithromycin-sensitive strains versus 18% in clarithromycin-resistant strains. Therefore, the background rate of clarithromycin resistance is critically important for the efficacy of standard triple therapy. Recently, several strategies including bismuth-containing quadruple therapy, non-bismuth quadruple therapy (i.e., sequential therapy, concomitant therapy and hybrid therapy) and high-dose dual therapy have been proposed to increase the eradication rate.

Hybrid therapy developed by our study group in 2011 consists of a dual therapy with a proton pump inhibitor (PPI) and amoxicillin for 7 days followed by a quadruple regimen with a PPI, amoxicillin, clarithromycin and metronidazole for 7 days [10]. It achieved an eradication rate of 97.4% by intention-to-treat (ITT) analysis and 99.1% by per-protocol (PP) analysis in a Taiwan population with clarithromycin resistance rate of 7%. Subsequent randomized controlled trials demonstrated that 14-day hybrid therapies were comparable or more effective than 10-day sequential therapies. A recent large multicentre randomized controlled trial documented that 14-day hybrid and 14-day concomitant therapies had comparable efficacy in the treatment of H. pylori infection, and both could cure more than 90% of patients with H. pylori infections in areas of high clarithromycin and metronidazole resistance [24]. Therefore, hybrid therapy has a great potential to replace bismuth quadruple therapy in the first-line treatment of H. pylori infection. Currently, hybrid therapy is a recommended first-line treatment for H. pylori infection in the ACG guideline

, Bangkok Consensus Report and Taiwan Consensus Report. High-dose dual therapy developed by Yang et al. is another emerging treatment for H pylori infection. The new therapy consists of high-dose PPI and amoxicillin, which keep the intragastric pH at a value higher than 6.5 regardless of CYP2C19 genotype and maintain steady plasma concentration of amoxicillin above the minimal inhibitory concentration (MIC) for H pylori [28]. The efficacy of the new therapy was significantly higher than that of standard triple therapy in Taiwan. However, it was less effective as the first-line therapy for eradicating H pylori in Korea and in the United States.

This study aims to better understand the potential of both hybrid and igh-dose dual therapies in the treatment of H. pylori infection.

Conditions

Helicobacter Pylori Infection

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

High dose dual therapy

Rabeprazole (Pariet) 20 mg and amoxicillin (Amolin) 750 mg q.i.d for 14 days

Group Type: EXPERIMENTAL

Pariet

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Amolin

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Hybrid therapy

Rabeprazole (Pariet) 20 mg and amoxicillin (Amolin) 1 g b.i.d. for 7 days, followed by rabeprazole (Pariet) 20 mg, amoxicillin(Amolin)1 g, clarithromycin (Klaricid) 500 mg, and metronidazole (Flagyl) 500 mg b.i.d. for 7 days

Group Type: ACTIVE_COMPARATOR

Pariet

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Amolin

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Klaricid

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 1 g bid. for 7 days, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg bid. for 7 days

Flagyl

Intervention Type: DRUG

Rabeprazole 20 mg and amoxicillin 1 g bid. for 7 days, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg bid. for 7 days

Interventions

Pariet

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Intervention Type: DRUG

Amolin

Rabeprazole 20 mg and amoxicillin 750 mg qid for 14 days

Intervention Type: DRUG

Klaricid

Rabeprazole 20 mg and amoxicillin 1 g bid. for 7 days, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg bid. for 7 days

Intervention Type: DRUG

Flagyl

Rabeprazole 20 mg and amoxicillin 1 g bid. for 7 days, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg bid. for 7 days

Intervention Type: DRUG

Other Intervention Names

Rabeprazole; Amoxicillin; Clarithromycin; Metronidazole

Eligibility Criteria

Inclusion Criteria

1. H. pylori-infected outpatients with endoscopically proven peptic ulcer diseases or gastritis.

Exclusion Criteria

1. Previous H. pylori-eradication therapy

2. ingestion of antibiotics, bismuth, or PPIs within the prior 4 weeks

3. patients with allergic history to the medications used

4. patients with previous gastric surgery

5. the coexistence of serious concomitant illness (for example, decompensated liver cirrhosis, uremia)

6. pregnant women.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Chang Gung Memorial Hospital

OTHER

Sponsor Role: lead

Responsible Party

Wei-Chen Tai M.D.

Associate professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Wei-Chen Tai, MD

Role: PRINCIPAL_INVESTIGATOR

Kaohsiung Chang Gung Memorial Hospital,Taiwan

Locations

Chang Gung Memorial Hospital

Kaohsiung City, , Taiwan

Countries

Taiwan

References

Tai WC, Yang SC, Yao CC, Wu CK, Liu AC, Lee CH, Kuo YH, Chuah SK, Liang CM. The Efficacy and Safety of 14-day Rabeprazole Plus Amoxicillin High Dose Dual Therapy by Comparing to 14-day Rabeprazole-Containing Hybrid Therapy for the Naive Helicobacter pylori Infection in Taiwan: A Randomized Controlled Trial. Infect Dis Ther. 2023 May;12(5):1415-1427. doi: 10.1007/s40121-023-00811-3. Epub 2023 May 3.

Reference Type: DERIVED

PMID: 37133673 (View on PubMed)

Other Identifiers

201800871A3

Identifier Type: -

Identifier Source: org_study_id