Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Issue 6 (14th January 2015)

• Record Type: Journal Article
• Authors: Molina‐Infante, J.; Lucendo, A. J.; Angueira, T.; Rodriguez‐Tellez, M.; Perez‐Aisa, A.; Balboa, A.; Barrio, J.; Martin‐Noguerol, E.; Gomez‐Rodriguez, B. J.; Botargues‐Bote, J. M.; Gomez‐Camarero, J.; Huerta, A.; Modolell, I.; Ariño, I.; Herranz‐Bachiller, M. T.; Bermejo, F.; McNicholl, A. G.; O'Morain, C.; Gisbert, J. P.; the European Registry on H. pylori management (Hp‐EuReg); Lima, A.; Tejero‐Bustos, M. A.; Sans, M.; Mearin, F.; Perez‐Lasala, J.; Mañas‐Gallardo, N.; Millastre, J.; Gracia, M.; Rodriguez‐Sanchez, J.; Rancel‐Medina, F. J.; Lanas, A.; Prados, S.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 41:Issue 6(2015)
• Page Start: 581
• Page End: 589
• Publication Date: 2015-01-14
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13069
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13069-abs-0001"> <title>Summary</title> <sec id="apt13069-sec-0001" sec-type="section"> <title>Background</title> <p>Empiric triple therapy for <italic>Helicobacter pylori</italic> should be abandoned when clarithromycin resistance rate is >15–20%. Optimisation of triple therapy (high‐dose acid suppression and 14‐day duration) can increase eradication rates by 10%.</p> </sec> <sec id="apt13069-sec-0002" sec-type="section"> <title>Aim</title> <p>To compare the efficacy and safety of optimised triple (OPT‐TRI) and nonbismuth quadruple concomitant (OPT‐CON) therapies.</p> </sec> <sec id="apt13069-sec-0003" sec-type="section"> <title>Methods</title> <p>Prospective multicentre study in 16 Spanish centres using triple therapy in clinical practice. In a 3‐month two‐phase fashion, the first 402 patients received an OPT‐TRI therapy [esomeprazole (40 mg b.d.), amoxicillin (1 g b.d) and clarithromycin (500 mg b.d) for 14 days] and the last 375 patients an OPT‐CON treatment [OPT‐TRI therapy plus metronidazole (500 mg b.d)].</p> </sec> <sec id="apt13069-sec-0004" sec-type="section"> <title>Results</title> <p>Seven‐hundred seventy‐seven consecutive patients were included (402 OPT‐TRI, 375 OPT‐CON). The OPT‐CON therapy achieved significantly higher eradication rates in the per‐protocol [82.3% (95% CI = 78–86%) vs. 93.8% (91–96%), <italic>P</italic> < 0.001] and intention‐to‐treat analysis [81.3% (78–86%) vs. 90.4% (87–93%), <italic>P</italic> < 0.001]. Adverse events (97% mild/moderate) were significantly more common with OPT‐CON therapy (39% vs. 47%, <italic>P</italic> = 0.016), but full compliance with therapy was similar between groups (94% vs. 92%, <italic>P</italic> = 0.4). OPT‐CON therapy was the only significant predictor of successful eradication (odds ratio, 2.24; 95% CI: 1.48–3.51, <italic>P</italic> < 0.001). The rate of participating centres achieving cure rates ≥90% favoured OPT‐CON therapy (OPT‐TRI 25% vs. OPT‐CON 62%).</p> </sec> <sec id="apt13069-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Empiric OPT‐CON therapy achieved significantly higher cure rates (>90%) compared to OPT‐TRI therapy. Addition of metronidazole to OPT‐TRI therapy increased eradication rates by 10%, resulting in more mild adverse effects, but without impairing compliance with therapy.</p> </sec> </abstract>