CYP2C19遺伝子多型に基づくHelicobacter pylori二次除菌療法の検討

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Proton pump inhibitor (PPI)-based triple therapy with 2 antibiotics is a routine treatment for the eradication of Helicobacter pylori (H. pylori) infection in patients with gastric and duodenal ulcers. While this regimen achieves a high eradication rate for H. pylori infection, approximately 20% of patients fail to respond to it and several recent studies have shown that clarithromycin (CAM) resistance, PPI metabolic enzyme genetic polymorphism, smoking habit, and non-adherence to medication are associated with unsuccessful eradication of H. pylori infection. In view of this, we introduced a second-line H. pylori infection eradication therapy based on testing for CYP2C19 genetic polymorphism as a routine hospital procedure. A total of 51 patients in whom the initial PPI-based regimen failed underwent the second-line therapy based on their genotypes with respect to CYP2C19. Of the 48 patients evaluated, 44 were extensive CYP2C19 metabolizers (EM : homoEM, 23 ; heteroEM, 21) and 4 were poor metabolizers (PM). The results of an antibiotic sensitivity test revealed CAM-resistant strains in 22 patients but AMPC-resistant strains were not evident. The EM group was retreated with 30 mg lansoprazole (LPZ) and 500mg amoxicillin (AMPC) 4 times a day for 2 weeks and the PM group was re-treated with 30mg LPZ twice a day and 500 mg AMPC 4 times a day for 2 weeks. The second-line therapy succeeded in 94% of the patients (45 of 48 patients). We established CYP2C19 genetic polymorphism testing as a routine hospital procedure in H. pylori infection eradication therapy using PPI+AMPC. The second-line therapy based on this regimen was sufficiently effective despite the absence of CAM sensitivity.
日本医療薬学会の論文
2007-03-10

CYP2C19遺伝子多型に基づくHelicobacter pylori二次除菌療法の検討

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