Is Tegoprazan-Based Triple Therapy Effective in Regions with High Rates of Clarithromycin Resistance?
Abstract
Triple therapy (consisting of a proton pump inhibitor [PPI], clarithromycin, and amoxicillin) is the standard first-line regimen for eradicating Helicobacter pylori infection. However, standard triple therapy has an unsatisfactory eradication rate, largely as a result of the increasing rate of antibiotic resistance. In response to the declining effectiveness of the standard triple therapy, treatments with various drug combinations for different durations have been introduced to improve the H. pylori eradication rate. According to the 2020 guidelines of Korea, 7-day triple therapy is the recommended first-line regimen in cases negative for clarithromycin resistance, whereas 14-day triple therapy is recommended in cases in which clarithromycin resistance testing was not performed. A potassium-competitive acid blocker (P-CAB)-based triple therapy has been suggested as an alternative to the standard triple therapy. P-CAB offers stronger and longerlasting gastric-acid suppression compared to other PPIs. Stronger acid suppression is linked to successful eradication of H. pylori. Based on this, we hypothesized that PCAB-based triple therapy would be superior to the standard treatment. Vonoprazan, a novel P-CAB approved in Japan, in combination with a triple-therapy regimen, reportedly achieves a higher eradication rate than PPI-based triple therapy. The Japanese guidelines now recommend vonoprazan-based triple therapy as the first-line regimen. Tegoprazan, another P-CAB, has been…
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