Esomeprazole 40 mg twice daily in triple therapy and the efficacy of Helicobacter pylori eradication related to CYP2C19 metabolism
Esomeprazole 40 mg twice daily in triple therapy and the efficacy of Helicobacter pylori eradication related to CYP2C19 metabolism
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DOI：
10.1111/j.1365-2036.2005.02281.x
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发表时间：
2005-02-01
影响因子：
7.6
通讯作者：
Wu, JJ
中科院分区：
文献类型：
--
作者：
Sheu, BS;Kao, AW;Wu, JJ
目的：探讨在三联疗法中增加40 mg/d埃索美拉唑能否提高不同基因型S-美苯妥因4‘-羟基酶(CYP2C19)患者的幽门螺杆菌根治率。方法：200例Hp感染的消化不良患者随机分为克拉霉素500 mg/d，阿莫西林1g/d，联合奥美拉唑20 mg/d或埃索美拉唑40 mg/d，疗程1周。六周后，幽门螺杆菌根除成功。结果：两组患者在年龄、性别、服药依从性及基因分型比例上差异无统计学意义。奥美拉唑组和埃索美拉唑组的幽门螺杆菌根治率也相似(意向治疗分析：79%对86%，P>；0.05；按方案分析：85%对94%，P>；0.05)。对于被归类为同源广谱代谢物的患者，埃索美拉唑组的Hp根除率显著高于奥美拉唑组(93%vs.76%，P<；0.05)。结论：埃索美拉唑每日2次40 mg三联疗法与基于奥美拉唑的同源广谱代谢物疗法相比，可提高Hp的根除效果，但仅对同源广谱代谢物CYP2C19有促进作用。
Aim: To determine whether an increased dosage of esomeprazole 40 mg twice daily in triple therapy improved the Helicobacter pylori eradication rate for patients with different genotypes of S-mephenytoin 4'-hydroxylase (CYP2C19).Methods: Two hundred H. pylori-infected dyspeptic patients were randomized to receive clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily plus either omeprazole 20 mg or esomeprazole 40 mg twice daily for 1 week. Six weeks later, the success of H. pylori eradication was defined. The genotyping of CYP2C19 in each patient was defined as homologous, heterologous extensive metabolizer or poor metabolizer.Results: The age, gender, drug compliance and proportion of CYP2C19 genotypes were similar between the two groups. The H. pylori eradication rates were also similar between the omeprazole group and the esomeprazole group (intention-to-treat analysis: 79% vs. 86%, P > 0.05; per-protocol analysis: 85% vs. 94%, P > 0.05). For patients classified as homologous extensive metabolizers, the per-protocol H. pylori eradication rate was significantly higher in the esomeprazole group than in the omeprazole group (93% vs. 76%, P < 0.05).Conclusion: Esomeprazole 40 mg twice daily for triple therapy may improve the H. pylori eradication compared to omeprazole-based therapy, but only for homologous extensive metabolizers of CYP2C19.