Spotlight on PCABs in H. pylori

Use of potassium-competitive acid blockers (PCABs) in Helicobacter pylori infection was the focus of a recent study, meta-analysis, and practice update.

The study, published by the Journal of Gastroenterology and Hepatology on Aug. 26, retrospectively compared tegoprazan, a PCAB, with rabeprazole as components of treatment for H. pylori, using data from two Korean hospitals. The analysis included 620 patients who received tegoprazan and 854 who received rabeprazole. In both intention-to-treat and per protocol analyses, the groups had similar eradication rates (74.7% vs. 72.7% and 88.0% vs. 85.9%, respectively). The overall adverse event rate did not differ between groups, but abdominal discomfort was less frequent with tegoprazan (1.3% vs. 4.8%; P=0.001). The study authors concluded that the drugs showed comparable efficacy and overall safety but that cost should also be a consideration and said future research should consider factors such as regional differences in clarithromycin resistance.

The meta-analysis, published by the American Journal of Gastroenterology on Sept. 19, assessed the efficacy and safety of dual, triple, or quadruple treatment regimens for H. pylori that were based on either PCABs or proton-pump inhibitors (PPIs). The 25 included trials randomized a total of 7,605 patients to any of the six regimens or controls. Overall, PCAB-based dual treatment ranked first for efficacy and had the best overall efficacy-safety profile, achieving an eradication rate of 85.2% in the intention-to-treat analysis and above 90% in the per protocol analysis. A limitation of this meta-analysis is that only one of the studies included patients in the U.S. and Europe and it did not result in a clinically acceptable cure rate among treated patients, leading the analysis authors to observe that “more data from other regions and countries are needed to enable us to judge the global performance of [PCAB] based regimens for first-line H. pylori infection treatment.”

A clinical practice update from the American Gastroenterological Association was published by Gastroenterology on Sept. 11 and offered nine best practice advice statements on the use of PCABs. Regarding H. pylori, it said clinicians should use PCABs in place of PPIs in eradication regimens for most patients. The statement does caution that some research suggests that PCABs may not be more effective than PPIs and more data “on the optimal utility [of PCABs]” in H. pylori, particularly in patients outside of Asia, are needed. Other best practice advice in the update addresses use of PCABs for acid-related conditions, heartburn symptoms, nonerosive reflux disease, erosive esophagitis, peptic ulcer disease, and bleeding gastroduodenal ulcers.