Article Search
검색
검색 팝업 닫기

Metrics

Help

  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

  • 2. Editorial Board

    Editor-in-Chief + MORE

    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
  • 3. Editorial Office
  • 4. Articles
  • 5. Instructions for Authors
  • 6. File Download (PDF version)
  • 7. Ethical Standards
  • 8. Peer Review

    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
    The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.

    The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.

Search

Search

Year

to

Article Type

Editorial

Split Viewer

Role of Tegoprazan in Helicobacter pylori Eradication Therapy

Jin Lee

Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Jin Lee
ORCID https://orcid.org/0000-0003-2404-385X
E-mail injemed76@naver.com

See “Triple Therapy-Based on Tegoprazan, a New Potassium-Competitive Acid Blocker, for First-Line Treatment of Helicobacter pylori Infection: A Randomized, Double-Blind, Phase III, Clinical Trial” by Yoon Jin Choi, et al. on page 535, Vol. 16, No. 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2022;16(4):493-494

Published online July 15, 2022, Published Date July 15, 2022 https://doi.org/10.5009/gnl220272

Copyright © Gut and Liver.

Potassium-competitive acid blockers (P-CABs) have a stronger acid-suppressing effect than proton pump inhibitors (PPI), showing comparable or superior effects in various diseases in which PPIs were used. Many studies have reported the role of P-CAB in Helicobacter pylori eradication. Vonoprazan is a novel P-CAB approved and used for H. pylori eradication in Japan. In recent years, several studies have compared the eradication rates of vonoprazan- and PPI-containing triple therapies across centers in Japan. The superior efficacy of vonoprazan-containing eradication treatment has been demonstrated in recent meta-analyses1-3 and is mainly explained by the rapid and potent suppression of gastric acid secretion. Tegoprazan is a P-CAB developed in Korea, and, similar to vonoprazan, it showed a stronger and faster effect than PPIs. Therefore, the rapid and potent anti-acid efficacy of tegoprazan is considered optimal for H. pylori eradication therapy.

In this issue of Gut and Liver, Choi et al.4 report the efficacy of tegoprazan as a part of first-line triple therapy for H. pylori eradication. A randomized, double-blind, controlled, multicenter study was performed to evaluate whether a 50-mg tegoprazan-based triple therapy was non-inferior to a 30-mg lansoprazole-based triple therapy. A total of 350 H. pylori-positive patients were randomly allocated to either the tegoprazan or lansoprazole groups. The H. pylori eradication rates in the tegoprazan and lansoprazole groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis, and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.0090 and p=0.0127). Although the results showed that tegoprazan was non-inferior to lansoprazole, the overall eradication rate was less than 70% in both groups. This is consistent with the recent trend of the lowering success rate of PPI-based triple therapy due to antibiotic resistance. The first-line therapy for H. pylori infection comprises triple therapy with the combination of a PPI, amoxicillin, and clarithromycin. However, the H. pylori eradication rate upon PPI-based triple therapy has fallen below 80% in many countries and has even reached 70% in Korea.5 The main cause of eradication failure has been attributed to the increased antibiotic resistance of H. pylori, particularly to clarithromycin.6

Acid inhibition of PPI is known to play an important role in eradication treatment, and based on this, it was expected that P-CAB, which has a strong acid inhibitory effect, could exhibit a better eradication rate for patients with clarithromycin-resistant strains. Murakami et al.7 reported that the eradication rate was significantly higher with vonoprazan than with lansoprazole in patients with clarithromycin-resistant strains (82% vs 40%, p=0.0001). Moreover, a recent meta-analysis showed that vonoprazan is superior to conventional PPIs in eradicating clarithromycin-resistant strains, while vonoprazan-based and conventional PPI-based therapies are similarly effective in patients with clarithromycin-susceptible strains.2 Additionally, the gastric acid inhibitory effect of PPI differs according to an individual’s CYP2C19 genotype, and vonoprazan is known to have a higher gastric acid inhibitory effect than other PPIs in extensive metabolizers. In fact, vonoprazan showed a superior effect compared to conventional PPIs in CYP2C19 extensive metabolizers during eradication treatment.7

Based on previous studies, tegoprazan, like vonoprazan, was expected to be superior to conventional PPIs in the clarithromycin-resistant group and CYP2C19 extensive metabolizers. In their study, however, Choi et al.4 did not show the superiority of tegoprazan in eradication rate. Subgroup analyses according to minimum inhibitory concentrations (MICs) or CYP2C19 genotype did not show any remarkable differences in eradication rates. As the authors mentioned in the discussion, there are several hypotheses as to why it is not superior to PPI in H. pylori eradication. The hypotheses are as follows: (1) insufficient dose of tegoprazan; (2) differences in the MIC distributions for clarithromycin-resistant H. pylori strains compared with those reported in the Japanese study; (3) pharmacological differences between tegoprazan and vonoprazan; and (4) insufficient eradication treatment period compared to 14 days of treatment. Additionally, all studies on vonoprazan-based H. pylori eradication were conducted in Japan; thus, it may be difficult to apply these findings to the general population because of the difference in the holding time ratio at pH >4 and the resistance pattern of H. pylori to antibiotics.

In summary, the authors provided evidence that tegoprazan-based 7-day triple therapy can be used as first-line H. pylori therapy, although tegoprazan doses do not overcome the clarithromycin resistance of H. pylori. Further studies on high-dose tegoprazan-based regimens, or 10- or 14-day triple therapy and analyses according to the MIC value, are needed to clarify whether tegoprazan-based therapy is more effective than PPI-based therapy for H. pylori eradication.

No potential conflict of interest relevant to this article was reported.

  1. Jung YS, Kim EH, Park CH. Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther 2017;46:106-114.
    Pubmed CrossRef
  2. Li M, Oshima T, Horikawa T, et al. Systematic review with meta-analysis: vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter 2018;23:e12495.
    Pubmed CrossRef
  3. Shinozaki S, Kobayashi Y, Osawa H, et al. Effectiveness and safety of vonoprazan versus proton pump inhibitors for second-line Helicobacter pylori eradication therapy: systematic review and meta-analysis. Digestion 2021;102:319-325.
    Pubmed CrossRef
  4. Choi YJ, Lee YC, Kim JM, et al. Triple therapy-based on tegoprazan, a new potassium-competitive acid blocker, for first-line treatment of Helicobacter pylori infection: a randomized, double-blind, phase iii, clinical trial. Gut Liver 2022;16:535-546.
    Pubmed CrossRef
  5. Jung HK, Kang SJ, Lee YC, et al. Evidence based guidelines for the treatment of Helicobacter pylori infection in Korea 2020. Korean J Intern Med 2021;36:807-838.
    Pubmed KoreaMed CrossRef
  6. Braden B. The best and worst treatments for Helicobacter pylori. BMJ 2015;351:h4146.
    Pubmed CrossRef
  7. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut 2016;65:1439-1446.
    Pubmed KoreaMed CrossRef

Article

Editorial

Gut and Liver 2022; 16(4): 493-494

Published online July 15, 2022 https://doi.org/10.5009/gnl220272

Copyright © Gut and Liver.

Role of Tegoprazan in Helicobacter pylori Eradication Therapy

Jin Lee

Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to:Jin Lee
ORCID https://orcid.org/0000-0003-2404-385X
E-mail injemed76@naver.com

See “Triple Therapy-Based on Tegoprazan, a New Potassium-Competitive Acid Blocker, for First-Line Treatment of Helicobacter pylori Infection: A Randomized, Double-Blind, Phase III, Clinical Trial” by Yoon Jin Choi, et al. on page 535, Vol. 16, No. 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

Potassium-competitive acid blockers (P-CABs) have a stronger acid-suppressing effect than proton pump inhibitors (PPI), showing comparable or superior effects in various diseases in which PPIs were used. Many studies have reported the role of P-CAB in Helicobacter pylori eradication. Vonoprazan is a novel P-CAB approved and used for H. pylori eradication in Japan. In recent years, several studies have compared the eradication rates of vonoprazan- and PPI-containing triple therapies across centers in Japan. The superior efficacy of vonoprazan-containing eradication treatment has been demonstrated in recent meta-analyses1-3 and is mainly explained by the rapid and potent suppression of gastric acid secretion. Tegoprazan is a P-CAB developed in Korea, and, similar to vonoprazan, it showed a stronger and faster effect than PPIs. Therefore, the rapid and potent anti-acid efficacy of tegoprazan is considered optimal for H. pylori eradication therapy.

In this issue of Gut and Liver, Choi et al.4 report the efficacy of tegoprazan as a part of first-line triple therapy for H. pylori eradication. A randomized, double-blind, controlled, multicenter study was performed to evaluate whether a 50-mg tegoprazan-based triple therapy was non-inferior to a 30-mg lansoprazole-based triple therapy. A total of 350 H. pylori-positive patients were randomly allocated to either the tegoprazan or lansoprazole groups. The H. pylori eradication rates in the tegoprazan and lansoprazole groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis, and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.0090 and p=0.0127). Although the results showed that tegoprazan was non-inferior to lansoprazole, the overall eradication rate was less than 70% in both groups. This is consistent with the recent trend of the lowering success rate of PPI-based triple therapy due to antibiotic resistance. The first-line therapy for H. pylori infection comprises triple therapy with the combination of a PPI, amoxicillin, and clarithromycin. However, the H. pylori eradication rate upon PPI-based triple therapy has fallen below 80% in many countries and has even reached 70% in Korea.5 The main cause of eradication failure has been attributed to the increased antibiotic resistance of H. pylori, particularly to clarithromycin.6

Acid inhibition of PPI is known to play an important role in eradication treatment, and based on this, it was expected that P-CAB, which has a strong acid inhibitory effect, could exhibit a better eradication rate for patients with clarithromycin-resistant strains. Murakami et al.7 reported that the eradication rate was significantly higher with vonoprazan than with lansoprazole in patients with clarithromycin-resistant strains (82% vs 40%, p=0.0001). Moreover, a recent meta-analysis showed that vonoprazan is superior to conventional PPIs in eradicating clarithromycin-resistant strains, while vonoprazan-based and conventional PPI-based therapies are similarly effective in patients with clarithromycin-susceptible strains.2 Additionally, the gastric acid inhibitory effect of PPI differs according to an individual’s CYP2C19 genotype, and vonoprazan is known to have a higher gastric acid inhibitory effect than other PPIs in extensive metabolizers. In fact, vonoprazan showed a superior effect compared to conventional PPIs in CYP2C19 extensive metabolizers during eradication treatment.7

Based on previous studies, tegoprazan, like vonoprazan, was expected to be superior to conventional PPIs in the clarithromycin-resistant group and CYP2C19 extensive metabolizers. In their study, however, Choi et al.4 did not show the superiority of tegoprazan in eradication rate. Subgroup analyses according to minimum inhibitory concentrations (MICs) or CYP2C19 genotype did not show any remarkable differences in eradication rates. As the authors mentioned in the discussion, there are several hypotheses as to why it is not superior to PPI in H. pylori eradication. The hypotheses are as follows: (1) insufficient dose of tegoprazan; (2) differences in the MIC distributions for clarithromycin-resistant H. pylori strains compared with those reported in the Japanese study; (3) pharmacological differences between tegoprazan and vonoprazan; and (4) insufficient eradication treatment period compared to 14 days of treatment. Additionally, all studies on vonoprazan-based H. pylori eradication were conducted in Japan; thus, it may be difficult to apply these findings to the general population because of the difference in the holding time ratio at pH >4 and the resistance pattern of H. pylori to antibiotics.

In summary, the authors provided evidence that tegoprazan-based 7-day triple therapy can be used as first-line H. pylori therapy, although tegoprazan doses do not overcome the clarithromycin resistance of H. pylori. Further studies on high-dose tegoprazan-based regimens, or 10- or 14-day triple therapy and analyses according to the MIC value, are needed to clarify whether tegoprazan-based therapy is more effective than PPI-based therapy for H. pylori eradication.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Jung YS, Kim EH, Park CH. Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther 2017;46:106-114.
    Pubmed CrossRef
  2. Li M, Oshima T, Horikawa T, et al. Systematic review with meta-analysis: vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter 2018;23:e12495.
    Pubmed CrossRef
  3. Shinozaki S, Kobayashi Y, Osawa H, et al. Effectiveness and safety of vonoprazan versus proton pump inhibitors for second-line Helicobacter pylori eradication therapy: systematic review and meta-analysis. Digestion 2021;102:319-325.
    Pubmed CrossRef
  4. Choi YJ, Lee YC, Kim JM, et al. Triple therapy-based on tegoprazan, a new potassium-competitive acid blocker, for first-line treatment of Helicobacter pylori infection: a randomized, double-blind, phase iii, clinical trial. Gut Liver 2022;16:535-546.
    Pubmed CrossRef
  5. Jung HK, Kang SJ, Lee YC, et al. Evidence based guidelines for the treatment of Helicobacter pylori infection in Korea 2020. Korean J Intern Med 2021;36:807-838.
    Pubmed KoreaMed CrossRef
  6. Braden B. The best and worst treatments for Helicobacter pylori. BMJ 2015;351:h4146.
    Pubmed CrossRef
  7. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut 2016;65:1439-1446.
    Pubmed KoreaMed CrossRef
Gut and Liver

Vol.16 No.5
September, 2022

pISSN 1976-2283
eISSN 2005-1212

qrcode
qrcode

Share this article on :

  • line

Popular Keywords

Gut and LiverQR code Download
qr-code

Editorial Office