title: Comparison of lansoprazole-based triple and dual therapy for treatment of Helicobacter pylori-related duodenal ulcer: an Asian multicentre double-blind randomized placebo controlled study.
abstract: BACKGROUND
  [corrected] In Asian countries with limited resources, clarithromycin-based triple therapy may not be readily available. There are also few direct comparisons of different regimens in Asia.
  
  
  OBJECTIVE
  To compare two lansoprazole-based non-clarithromycin triple therapies and one dual therapy in a prospective double-blind placebo-controlled study of Helicobacter pylori eradication and duodenal ulcer healing.
  
  
  METHODS
  Fourteen centres in Asia participated in this study. Patients with acute duodenal ulcer who were H. pylori-positive were recruited. They were randomized to receive: (a) lansoprazole 30 mg b.d., amoxycillin 1 g b.d. and metronidazole 500 mg b.d. for 2 weeks (LAM-2 W), or (b) LAM for 1 week and placebo (LAM-1 W), or (c) lansoprazole 30 mg b.d., amoxycillin 1 g b.d. and placebo for 2 weeks (LA-2 W). Upper endoscopy was repeated at week 6 to check for duodenal ulcer healing. Symptoms and side-effects were recorded.
  
  
  RESULTS
  A total of 228 patients were recruited, and two patients took less than 50% of the drugs. H. pylori eradication rates (intention-to-treat) were 68 out of 82 (83%) with LAM-2 W, 55 out of 71 (78%) with LAM-1 W and 43 out of 75 (57%) with LA-2 W. There were significant differences (P=0. 001) in eradication rates when comparing either LAM-2 W or LAM-1 W with LA-2 W. The eradication rate in patients with metronidazole resistant H. pylori strains were significantly lower than those with metronidazole sensitive strains (P=0.0001). The duodenal ulcer healing rates at week 6 were 85%, 85% and 72% in LAM-2 W, LAM-1 W and LA-2 W, respectively (P=0.065). Side-effects occurred in 13%, 11% and 9% in LAM-2 W, LAM-1 W and LA-2 W, respectively. H. pylori eradication and initial ulcer size were factors affecting duodenal ulcer healing.
  
  
  CONCLUSIONS
  This Asian multicentre study showed that 1-week lansoprazole-based triple therapy without clarithromycin has similar efficacy in H. pylori eradication and ulcer healing compared with a 2-week regimen. Both triple therapies were significantly better than dual therapy in H. pylori eradication. Therefore, 1-week lansoprazole-based triple therapy is as safe and effective as 2-week therapy in eradication of H. pylori infection and healing of duodenal ulcer in these Asian centres.
authors.affiliation: Department of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: B C
authors.initials: BC
authors.lastname: Wong
authors.forename: S D
authors.initials: SD
authors.lastname: Xiao
authors.forename: F L
authors.initials: FL
authors.lastname: Hu
authors.forename: S C
authors.initials: SC
authors.lastname: Qian
authors.forename: N X
authors.initials: NX
authors.lastname: Huang
authors.forename: Y Y
authors.initials: YY
authors.lastname: Li
authors.forename: P J
authors.initials: PJ
authors.lastname: Hu
authors.lastname: Daldiyono
authors.forename: C
authors.initials: C
authors.lastname: Manan
authors.forename: L
authors.initials: L
authors.lastname: Lesmana
authors.forename: R E
authors.initials: RE
authors.lastname: Carpio
authors.forename: J Y
authors.initials: JY
authors.lastname: Perez
authors.forename: K M
authors.initials: KM
authors.lastname: Fock
authors.forename: U
authors.initials: U
authors.lastname: Kachintorn
authors.forename: K
authors.initials: K
authors.lastname: Phornphutkul
authors.forename: P
authors.initials: P
authors.lastname: Kullavanijaya
authors.forename: J
authors.initials: J
authors.lastname: Ho
authors.forename: S K
authors.initials: SK
authors.lastname: Lam
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001208:Asia; D001944:Breath Tests; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial / Q000502:physiology; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy*; D004724:Endoscopy; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012307:Risk Factors; D014508:Urea / Q000032:analysis
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D008795:Metronidazole; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin; D009853:Omeprazole