Impact of rabeprazole, a new proton pump inhibitor, in triple therapy for Helicobacter pylori infection - comparison with omeprazole and lansoprazole

Background: A recent trend in curative therapy for Helicobacter pylori infe ction is the so-called triple therapy, which consists of a proton pump inhi bitor (PPI) and two different antimicrobials. Various regimens employing th is triple therapy have been reported. However, little is known about the ef fectiveness of rabeprazole, a recently developed proton pump inhibitor, whe n used in the triple therapy. Aim: To validate its usefulness by comparing rabeprazole with omeprazole an d lansoprazole, in combination with amoxycillin and clarithromycin. Patients and methods: 221 H. pylori-positive patients with peptic ulcer dis ease were randomized to receive one of three different proton pump inhibito r/amoxycillin-clarithromycin (PPI/AC) regimens for 7 days. (i) OAC regimen (n = 75): omeprazole 20 mg b.d., amoxycillin (AMOX) 500 mg t.d.s. and clari thromycin (CAM) 200 mg b.d.; (ii) LAC regimen (n = 74): lansoprazole 30 mg b.d., AMOX 500 mg t.d.s. and CAM 200 mg b.d.; and (iii) RAC regimen (n = 72 ): rabeprazole 20 mg b.d., AMOX 500 mg t.d.s. and CAM 200 mg b.d. Cure of t he infection was determined by the C-13 urea breath test 1 month after comp letion of the treatment. Results: Intention-to-treat based cure rates for OAC, LAC and RAC regimens were 85% (95% CI, 75-92), 84% (95%, CI 73-91) and 88% (95% CI, 78-94), resp ectively, and per protocol based cure rates of these regimens were 88% (95% CI, 78-94), 91% (95%, CI 82-99) and 93% (95% CI, 84-98), respectively. Adv erse effects in the entire study population, which included diarrhoea, glos sitis or skin rash, were reported by 15% of the patients, and complete comp liance was achieved in 95% of these patients. Conclusion: 1-week proton pump inhibitor/AC regimens for H. pylori infectio n were effective in the Japanese population. Rabeprazole can be considered as equivalent to omeprazole and lansoprazole in the PPI/AC triple therapy.