Therapeutic Trial Comparing Triple Therapy Guided by the PCR Detection of Clarithromycin Resistance vs Empiric Concomitant Quadruple Therapy for Helicobacter Pylori Infection

NCT02576236 | Unknown DMC

• 2 other identifiers: P1409282015-A00457-42
• Study Type: interventional
• Target: 2,500
• Locations: 1 country
• Sites: 1

Brief Summary

The H pylori infection remains a public health problem. The eradication rate with the first line triple therapy (PPI-amoxicillin-clarithromycin) is insufficient (estimated at 70%) due to the frequency of resistance to clarithromycin, which reaches 21% in France. Until now,European and French consensus recomended tofavor sequential therapy (5 days PPI-amoxicillin and 5 days PPI-clarithromycin-metronidazole) or quadruple bismuth therapy ( 10 days PPI-tetracyclin,-metronidazole- bismuth). Studies in countries with low prevalence of clarithromycin resistance reported eradication rate of 85% with sequential therapy and reported a low impact of clarithromycin resistance on the effectiveness of this treatment. However, recent studies suggest a greater impact of clarithromycin resistance. Recent meta-analysis shows that empiric sequential therapy is less efficacious than concomitant quadruple therapy. Therefore, recent Maastricht V / Florence meeting October 7-8 2015) recommended to abandon sequential therapy and to favor 14 days concomitant therapy in first line in order to reach an eradication rate \>90%. In a multicenter randomized clinical trial (HELICOSTIC 2010-2011 AO ICST 2009), we compared a triple therapy guided by the results of a PCR test that detects resistance to clarithromycin and levofloxacin (HelicoDR ®) to empirical triple therapy (PPI-amoxicillin-clarithromycin). 1384 patients and among them 526 infected patients were enrolled in 10 centers. The results in 415 patients were 73.1% for the empirical treatment versus 85.5% (p \<0.001) for the treatment guided by PCR HelicoDR®. This study also demonstrated the limits of the test HelicoDR®: onerous, possibility of contamination, little practical contribution of the determination of resistance to quinolones. Moreover, it has been shown that triple therapy efficiency could be optimized by increasing duration up to 14 days and increasing dose of PPI to 40mg b.d;.and eradications rates \> 90% were reported with susceptible to clarithromycin strains. Adverse events are less common with optimized triple therapy than with concomitant quadruple therapy. The main objective is to compare the efficacy of optimized triple therapy guided by the results of a PCR test (eradication rates 90% hypothesized) with quadruple concomitant therapy (eradication rate 90% hypothesized). The secondary objective is to determine side effects of optimized guided triple therapy as well as the quadruple concomitant therapy in France.

Conditions

H Pylori Infection Eradication; Antibiotics Therapeutic Strategies; H Pylori Eradication

Keywords

Naïve patient; Suspicion of H pylori infection; Endoscopy; Antibiotics therapeutic strategies; Urea breath test

Outcome Measures

Primary Outcomes (1)

• Eradication rate on the basis of a negative C13 - urea breath test done 6-12 weeks after the end of treatment

  Eradication rates will be compared between the patients allocated to standard treatment currently recommended (quadruple concomitant treatment, control group) and patients allocated to triple therapy chosen according to the results of molecular detection of clarithromycin resistance (guided triple therapy,, test group). The breath test is recognized as a sensitive and specific test for infection with H. pylori, particularly in the context of monitoring the efficacy of treatment. It will be carried out blindly to allocated group.

  at 34 month

Secondary Outcomes (1)

• Safety criteria will include all adverse events occurring in the two treatment groups

  at 34 month

Study Arms (2)

Triple therapy guided by result of the molecular resistance

EXPERIMENTAL

* If clarithromycin S : high dose PPI (Esoméprazole 40mg X 2/ d) - amoxicillin 1gX2 / d - clarithromycin 500mgX2 / d The total duration of treatment is 14 days. * If clarithromycin R: high dose PPI (Esoméprazole 40mg X 2/ d) - amoxicillin 1gX2 / d- levofloxacin 500mg X2 / d The total duration of treatment is 14 days.

Other: Triple therapy guided by the result of the molecular resistance test

Quadruple concomitant therapy

ACTIVE COMPARATOR

high dose PPI (Esoméprazole 40 mg X 2 / d- amoxicillin 1gX2 / d - - clarithromycin 500mgX2 / d - metronidazole 500mgX2 / d for 14 days

Other: Quadruple concomitant therapy treatment

Interventions

Quadruple concomitant therapy treatment OTHER

Quadruple concomitant therapy treatment: high dose PPI (Esoméprazole 40 mg X 2 / d- amoxicillin 1gX2 / d - - clarithromycin 500mgX2 / d - metronidazole 500mgX2 / d for 14 days

Also known as: therapeutic procedure

Quadruple concomitant therapy

Triple therapy guided by the result of the molecular resistance test OTHER

Triple therapy guided by the result of the molecular resistance test: * If clarithromycin S : high dose PPI (Esoméprazole 40mg X 2/ d) - amoxicillin 1gX2 / d - clarithromycin 500mgX2 / d The total duration of treatment is 14 days. * If clarithromycin R: high dose PPI (Esoméprazole 40mg X 2/ d) - amoxicillin 1gX2 / d- levofloxacin 500mg X2 / d The total duration of treatment is 14 days.

Also known as: therapeutic procedure

Triple therapy guided by result of the molecular resistance

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients ≥ 18 years
• Hospitalized or out-patients referred to one of the participating centers for upper gastrointestinal endoscopy
• Who did not received a previous eradication treatment
• Willing to participate and signed inform consent. Finally only patients with bacteriologically documented H. pylori infection (PCR) will be included.

You may not qualify if:

• Patient having already been treated to eradicate H pylori
• No affiliation to social insurance
• Person under legal protection
• Refusal for signing informed consent
• Patient included in another trial with medication
• Patient unable to take oral medication ongoing
• Patient with severe life-threatening disease in the short term
• Contraindication to the PPIs, amoxicillin, metronidazole, clarithromycin, levofloxacin, tetracyclin or bismuth
• Patient under treatment with antibiotics or PPI without possibility of interruption for 4 weeks
• Pregnant or breast-feeding woman

Sponsors & Collaborators

• Assistance Publique - Hôpitaux de Paris: lead

Study Sites (1)

Henri Mondor Hospital

Créteil, 94010, France

RECRUITING

Related Publications (1)

• Amiot A, Hacoon J, Heluwaert F, Mion F, Lamarque D, Moussata D, Mimouni M, Delchier JC, Durand-Zaleski I, Audureau E, Bastuji-Garin S; HEPYSE Study Group. 14-day tailored PCR-guided triple therapy versus 14-day non-Bismuth concomitant quadruple therapy for Helicobacter pylori eradication: A multicenter, open-label randomized noninferiority controlled trial. Helicobacter. 2024 Mar-Apr;29(2):e13076. doi: 10.1111/hel.13076.

  PMID: 38680067 DERIVED

MeSH Terms

Interventions

Coal Tar

Intervention Hierarchy (Ancestors)

Tars; Complex Mixtures

Study Officials

• Jean-Charles Delchier, MD

  Assistance Publique - Hôpitaux de Paris

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 30, 2015
• First Posted: October 15, 2015
• Study Start: May 1, 2016
• Primary Completion: February 1, 2019
• Study Completion: March 1, 2019
• Last Updated: July 5, 2017

Record last verified: 2017-06

Locations

FR (1)