Comparison of Lafutidine and Rabeprazole in 7-day Second-line Amoxicillin- and Metronidazole-Containing Triple Therapy for Helicobacter pylori: A Pilot Study

Background: Lafutidine is an H2-receptor antagonist with gastroprotective action through capsaicin-sensitive afferent neurons and relatively inexpensive compare to proton-pump inhibitors (PPIs). A 7-day course of PPIs-amoxicillin-metronidazole is recommended as standard second-line Helicobacter pylori therapy and is covered by national health insurance in Japan. The aim of this study was to determine the efficacy and safety of second-line eradication using the H2-receptor antagonist lafutidine as a substitute for a PPI. Materials and Methods: Fifty-two patients who failed in first-line eradication using PPI-amoxicillin-clarithromycin were randomly assigned to a 7-day course of rabeprazole at 10mg b.i.d., amoxicillin at 750mg b.i.d., and metronidazole at 250mg b.i.d. (RPZ-AM) or a 7-day course of lafutidine at 10mg t.i.d., amoxicillin at 750mg b.i.d., and metronidazole at 250mg b.i.d. (LFT-AM) as second-line therapy. Eradication was assessed by the ¹³C urea breath test. A drug susceptibility test was performed before the second-line therapy. Results: Prior to second-line H. pylori eradication, the rate of resistance to clarithromycin was 86.5% and the rate of resistance to metronidazole was 3.8%. The eradication rates for both LFT-AM and RPZ-AM groups were 96% (95%CI=88.6-100%). There were no severe adverse events in either group. Conclusions: Lafutidine plus metronidazole-amoxicillin as second-line therapy provided a high eradication rate and safe treatment similar to a PPI-based regimen. Lafutidine-based eradication therapy is therefore considered to be a promising alternative and is also expected to reduce health care costs in H. pylori eradication.