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Comment #2 on "First-Line Helicobacter pylori Eradication with Vonoprazan, Clarithromycin, and Metronidazole in Patients Allergic to Penicillin".

Recently, Sue et al. published an open-label study, aiming to assess the efficacy of a 7-day first-line Helicobacter pylori (H. pylori) eradication regimen with vonoprazan (VPZ), clarithromycin (CAM), and metronidazole (MNZ), in patients with penicillin allergy [1]. In a letter to the editor, Kashani and Abadi raised several criticisms of this article [2]. The authors responded [3], but we want to focus on two not redundant points.

Considering appropriate some considerations (already reported by Sue et al.), especially those of the lack of controls and of the small sample size, we do not agree with two points. First, in the letter, it is reported that the factors affecting the success rate of H. pylori therapy were not checked and, among those, smoking habits and alcohol-drinking habits were reported. About these factors, there is no universal agreement in the literature [4, 5] and guidelines [6] on their ability to predict a poor response.

Second, Kashani and Abadi reported the need to evaluate CAM and MNZ resistance before deciding the appropriate treatment [2]. This is correct [7]; however, it should be highlighted that it is possible to obtain H. pylori eradication with VPZ-based therapy in 70.2% of patients in whom rabeprazole-based therapy (with the same antibiotics) has failed [8]. Thus, VPZ-based treatment shows a relatively high eradication rate against clarithromycin-resistant H. pylori. A plausible explanation is that, since VPZ and CAM are metabolized by CYP3A4, a combined treatment with these three drugs can delay their clearance permitting a prolonged and more potent effect. In addition, the strong and fastacting acid inhibitory effect of VPZ allowed the antibiotics to eradicate H. pylori [9]. Nevertheless, the efficacy of VPZ has not been reported for the combination of VPZ, CAM, and MNZ. Regarding the comment of Kashani and Abadi on the need to evaluate MNZ resistance by susceptibility tests, we would highlight that this resistance, although highly prevalent, can be partly overcome and is of secondary importance. Hence, the need to evaluate MNZ resistance patient-bypatient could not be useful. It would be better to know in a specific population MNZ and CAM resistance rates and apply the recommendation of the more updated guidelines [6].

https://doi.org/10.1155/2018/5260358

Disclosure

The contents of this article are the sole responsibility of the author and necessarily represent personal perspective.

Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interests.

References

[1] S. Sue, N. Suzuki, W. Shibata et al., "First-line Helicobacter pylori eradication with vonoprazan, clarithromycin, and metronidazole in patients allergic to penicillin," Gastroenterology Research and Practice, vol. 2017, Article ID 2019802, 6 pages, 2017.

[2] N. Kashani and A. Talebi Bezmin Abadi, "Comment on "Firstline Helicobacter pylori eradication with vonoprazan, clarithromycin, and metronidazole in patients allergic to penicillin"," Gastroenterology Research and Practice, vol. 2018, Article ID 5173904, 3 pages, 2018.

[3] S. Sue, N. Suzuki, W. Shibata et al., "Response to: Comment on "First-line Helicobacter pylori eradication with vonoprazan, clarithromycin, and metronidazole in patients allergic to penicillin"," Gastroenterology Research and Practice, vol. 2018, Article ID 8046838, 2 pages, 2018.

[4] S. Y. Liu, X. C. Han, J. Sun, G. X. Chen, X. Y. Zhou, and G. X. Zhang, "Alcohol intake and Helicobacter pylori infection: a dose-response meta-analysis of observational studies," Infectious Diseases, vol. 48, no. 4, pp. 303-309, 2015.

[5] D. B. Namiot, K. Leszczynska, Z. Namiot, A. J. Kurylonek, and A. Kemona, "Smoking and drinking habits are important predictors of Helicobacter pylori eradication," Advances in Medical Sciences, vol. 53, no. 2, pp. 310-315, 2008.

[6] P. Malfertheiner, F. Megraud, C. A. O'Morain et al., "Management of Helicobacter pylori infection - the Maastricht V/Florence Consensus Report," Gut, vol. 66, no. 1, pp. 6-30, 2017.

[7] D. Y. Graham, S. Fagoonee, and R. Pellicano, "Increasing role for modified bismuth-containing quadruple therapies for Helicobacter pylori eradication," Minerva Gastroenterologica Dietologica, vol. 63, pp. 77-79, 2017.

[8] T. Inaba, M. Iwamuro, T. Toyokawa, and H. Okada, "Letter: promising results of Helicobacter pylori eradication with vonoprazan-based triple therapy after failure of proton pump inhibitor-based triple therapy," Alimentary Pharmacology & Therapeutics, vol. 43, no. 1, pp. 179-180, 2016.

[9] X. Yang, Y. Li, Y. Sun et al., "Vonoprazan: a novel and potent alternative in the treatment of acid-related diseases," Digestive Diseases and Sciences, vol. 63, no. 2, pp. 302-311, 2018.

Davide Giuseppe Ribaldone (iD) (1) and Marco Astegiano (2)

(1) Department of Medical Sciences, Division of Gastroenterology, University of Turin, C.so Bramante 88, 10126 Turin, Italy

(2) Department of General and Specialist Medicine, Gastroenterology-U, Citta della Salute e della Scienza di Torino, Italy

Correspondence should be addressed to Davide Giuseppe Ribaldone; davrib_1998@yahoo.com

Received 27 February 2018; Accepted 26 August 2018; Published 16 December 2018

Academic Editor: Tatsuya Toyokawa
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Author:Ribaldone, Davide Giuseppe; Astegiano, Marco
Publication:Gastroenterology Research and Practice
Article Type:Letter to the editor
Date:Jan 1, 2018
Words:802
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