Author(s)

Masahiko Ohtaka^1,2, Mika Miura^1,2, Mitsuhiko Hanawa^1,2, Yuichi Hirose¹, Atsuko Kitahashi¹, Naoki Imamura¹, Ikko Watanabe¹, Kazuhiko Takaso¹, Naoki Shimura¹, Yoshioki Yoda¹, Ichiro Takayama³, Mitsuharu Fukasawa², Nobuyuki Enomoto²

¹Yamanashi Koseiren Health Care Center, Yamanashi, Japan.
²First Department of Internal Medicine, Graduate School of Medical and Engineering Science, University of Yamanashi, Yamanashi, Japan.
³Health Care Center, University of Yamanashi, Yamanashi, Japan.

Aim: To investigate the efficacy and tolerability of second-line metronidazole triple therapy with vonoprazan (VPZ) for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with second-line (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies. Successful eradication rates were compared between two groups: those receiving VPZ and those receiving a proton pump inhibitor (PPI). Adverse events were also investigated. Results: Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for PPI therapy. There were no significant differences between treatment groups. The eradication rates in those who had received first-line VPZ therapy previously according to ITT and PP analysis were 75.2% and 88.1%, respectively; in contrast, values were 82.5% and 95.4%, respectively, for those who had received first-line PPI therapy previously. In second-line therapy, the overall adverse event rate for VPZ therapy was the same as for PPI therapy. Conclusions: The efficacy and tolerability of metronidazole-containing second-line triple therapy with VPZ or a PPI were equivalent.

Vonoprazan, Metronidazole, Proton Pump Inhibitor, Second-Line Eradication, Helicobacter pylori

Ohtaka, M. , Miura, M. , Hanawa, M. , Hirose, Y. , Kitahashi, A. , Imamura, N. , Watanabe, I. , Takaso, K. , Shimura, N. , Yoda, Y. , Takayama, I. , Fukasawa, M. and Enomoto, N. (2018) Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors. Open Journal of Gastroenterology, 8, 27-38. doi: 10.4236/ojgas.2018.81003.