“7, 10 and 14-days rabeprazole-based standard triple therapies for H. pylori eradication : Are they still effective ? A randomized trial"

Background & study aims : Increasing data suggests that the efficiency of standard triple therapies of 7-10-14 days duration has fallen below the threshold for acceptability (80% cure rates in intention to treat analysis). Use of rabeprazole, a PPI less influ- enced by CYP2C19 gene polymorphisms is reported to lead to improved eradication rates. This study aims to re-examine the effectiveness of 7-10-14 days triple therapies based on rabeprazole in Greek patients. Patients and methods : 307 patients, from 2 endoscopic centers in Greece, were randomized to receive Rabeprazole 20mg bid, Clarithromycin 500 mg bid, and Amoxycillin 1gr bid for 7-days, for 10-days or for 14-days. Cure rates were assessed by CLO-test and histology. Clarithromycin sensitivity tests were carried out in the cultured pre-treatment H. pylori strains. The success rates were calculated by both intention-to-treat (ITT) and per protocol (PP) analyses. Results : The eradication rates according to ITT analyses were 74.5% (95% CI : 66.5-82.9%) for 7-days, 80.6% (95% CI : 73.2- 88.2%) for 10-days and 90.2% (95% CI : 84.5-95.9%) for 14-days treatment. PP cure rates were 76% (95% CI : 68.4-85.0%) for 7- days, 83% (95% CI : 76.6-91.0%) for 10-days and 93.9% (95% CI : 86.7-97.3%) for 14-days treatment. Side effects were general- ly minor and comparable in all treatment groups. Conclusions : Both 10- and 14-days rabeprazole-based triple regimens reached eradication rates above the threshold of 80% on an intention to treat basis. In our setting, the current regimen using rabeprazole, amoxicillin and clarithromycin was well tolerated, is still effective and should continue to be recommended as first-line therapy for H. pylori eradication. (Acta gastroenterol. belg., 2011, 74, 407-412).