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The decreasing efficacy of H. pylori eradication treatments over time makes the search for better regimens and adjuvant medications a priority.
Dr McNicholl and colleagues from Spain conducted a meta-analysis of studies comparing rabeprazole or esomeprazole with other proton pump inhibitors (PPI) or with each other in H. pylori eradication treatment. The team evaluated randomized clinical trials comparing esomeprazole or rabeprazole with first-generation PPIs (omeprazole-lansoprazole-pantoprazole) or with each other.
The meta-analysis showed higher eradication rates for esomeprazole than for first-generation PPIs. Rabeprazole also showed better results than first-generation PPIs.  | | Esomeprazole and rabeprazole show better overall H. pylori eradication rates | | Alimentary Pharmacology & Therapeutics |
On performing a PPI dosage sub-analysis, the team found that only esomeprazole 40 mg b.d. improved results. Whereas rabeprazole 10 and 20 mg b.d. maintained results, esomeprazole 20 mg b.d. obtained lower efficacy. On perfomring a substudy comparing esomeprazole with rabeprazole, the team found no significant differences. On CYP2C19 sub-analysis, the researchers found that genotype did not significantly affect eradication either in first or new generation PPIs. However, sub-analysis considering only extensive metabolizer patients showed higher eradication with new-generation PPIs.
Dr McNicholl's team concludes, "Esomeprazole and rabeprazole show better overall H. pylori eradication rates than first-generation PPIs." "This clinical benefit is more pronounced in esomeprazole 40 mg b.d. regimens." "In CYP2C19 extensive metabolisers, new-generation PPIs are more effective than first-generation PPIs for H. pylori eradication." "However, a general recommendation of using new-generation PPIs in all scenarios remains unclear."
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