Ignite Creation Date:
2024-05-06 @ 2:38 AM
Last Modification Date:
2024-10-26 @ 11:21 AM
Study NCT ID:
NCT02092506
Status:
COMPLETED
Last Update Posted:
2014-07-08
First Post:
2014-02-20
Brief Title:
RCT Triple vs Sequential vs Concomitant Therapy H Pylori
Sponsor:
Changi General Hospital
Organization:
Changi General Hospital
Study Overview
Official Title:
A Randomized Controlled Trial of Triple Therapy Versus Sequential Therapy Versus Concomitant Therapy as First Line Treatment for Helicobacter Pylori Infection
Status:
COMPLETED
Status Verified Date:
2014-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Triple therapy TT comprising proton pump inhibitor PPI amoxicillin 1g and clarithromycin 500mg twice daily has long been considered one of the standard treatment for H pylori infection as initial studies demonstrated success rates of 90 on per protocol analysis PP and 80 on intention to treat ITT analysis However increasing bacterial resistance especially to clarithromycin has been reported and there are concerns that the efficacy of TT has decreased Sequential therapy ST is an alternative first line therapy that consists of 5 days of treatment with a PPI and amoxicillin followed by 5-day treatment with the PPI and clarithromycin and metronidazole The rationale for this approach is that amoxicillin may weaken the bacterial cell wall in the initial phase of treatment and prevent the development of drug efflux channels that inhibit clarithromycin from binding to ribosomes and thus help to improve the efficacy of clarithromycin in the second phase of treatment A recent meta-analysis based on mainly European studies showed that the success rate of ST compared to TT was 928 - 96 vs 762 - 788 Concomitant therapy CT is another alternative first line treatment that consists of 10 days of PPI amoxicillin clarithromycin and metronidazole The rationale for using CT as a first line treatment option is to address the possibility of clarithromycin resistance which is increasingly encountered in clinical practice Currently there are no randomized controlled studies that compared TT with ST in Singapore although both regimens are being used in routine clinical practice The hypothesis is that ST is superior to TT as first line treatment for H pylori infection
The study aim to compare 10-day TT versus 10-day ST versus 10-day CT as first line treatment for H pylori infection in Singapore
The study aim to compare 10-day TT versus 10-day ST versus 10-day CT as first line treatment for H pylori infection in Singapore
Detailed Description:
Background Helicobacter pylori is a common infection in Singapore with an overall seroprevalence rate of 31 The prevalence rate increases with age and exceeds 70 among those more than 65 years of age 1 H pylori is a major pathogen and is associated with development of peptic ulcer disease and gastric malignancies and successful H pylori eradication has been shown to be important for both primary and secondary prevention of these diseases 2 Triple therapy TT comprising proton pump inhibitor PPI amoxicillin 1g and clarithromycin 500mg twice daily has long been considered one of the standard treatment for H pylori infection 2 3 as initial studies demonstrated success rates of 90 on per protocol analysis PP and 80 on intention to treat ITT analysis However increasing bacterial resistance especially to clarithromycin has been reported and there are concerns that the efficacy of TT has decreased Sequential therapy ST is an alternative first line therapy that consists of 5 days of treatment with a PPI and amoxicillin followed by 5-day treatment with the PPI and clarithromycin and metronidazole The rationale for this approach is that amoxicillin may weaken the bacterial cell wall in the initial phase of treatment and prevent the development of drug efflux channels that inhibit clarithromycin from binding to ribosomes and thus help to improve the efficacy of clarithromycin in the second phase of treatment A recent meta-analysis based on mainly European studies showed that the success rate of ST compared to TT was 928 - 96 vs 762 - 788 4 Concomitant therapy CT is another alternative first line treatment that consists of 10 days of PPI amoxicillin clarithromycin and metronidazole The rationale for using CT as a first line treatment option is to address the possibility of clarithromycin resistance which is increasingly encountered in clinical practice 5 Currently there are no randomized controlled studies that compared TT with ST in Singapore although both regimens are being used in routine clinical practice The hypothesis is that ST is superior to TT as first line treatment for H pylori infection
Aim 10-day triple therapy TT twice daily proton pump inhibitors PPI amoxicillin 1 g and clarithromycin 500mg versus 10-day sequential therapy ST 5 day PPI and amoxicillin 1g twice daily followed by 5 days PPI clarithromycin 500mg and metronidazole 400mg twice daily versus 10-day concomitant therapy CT twice daily PPI amoxicillin 1g clarithromycin 500mg and metronidazole 400mg as first line treatment for H pylori infection
Patients and Methods
Study Design
Prospective randomized controlled study
Treatment H pylori infected patients will be randomized to be treated using either 10 day TT PPI amoxicillin 1g clarithromycin 500mg twice daily or 10-day ST PPI and amoxicillin 1 g twice daily x 5 days followed by PPI clarithromycin 500mg metronidazole 400mg twice daily x 5days or 10-day CT PPI amoxicillin 1g clarithromycin 500mg metronidazole 400mg twice daily The success of treatment will be defined as either a negative carbon urea breath test CUBT or negative histology performed more than 4 weeks after completion of treatment CUBT or histology will be performed based on the clinical indication as determined by the attending physician All patients should be off PPI for at least 2 weeks or histamine 2 receptor antagonists for at least 1 week prior to assessment of the success of treatment as per standard practice The compliance to treatment in terms of percentage of drugs taken will be assessed during clinic review
Antibiotic susceptibility testing For patients with H pylori infection diagnosed during endoscopy from a positive rapid urease test kit the material from the test kit will be used sent for antibiotic susceptibility testing whenever it is technically feasible This may be of value in guiding the choice of antibiotics for second line salvage treatment should first line treatment fails
Statistical analysis
A treatment success rate of 80 is regarded as the minimum acceptable threshold for empiric first line therapy Data from several countries have suggested that the success rate of triple therapy may be lower than 80 whereas that for concomitant therapy may exceed 90 Thus for the study to have 80 power with significance level of 5 the minimum number of patients to be recruited into each arm will be 138 if the highest success rate is 91 and lowest success rate is 79 Randomization will be performed in blocks of 15 Categorical data will be analysed using Chi-square or Fisher exact test while continuous data will be analysed using students t test A p value of 005 will be taken as statistically significant
Aim 10-day triple therapy TT twice daily proton pump inhibitors PPI amoxicillin 1 g and clarithromycin 500mg versus 10-day sequential therapy ST 5 day PPI and amoxicillin 1g twice daily followed by 5 days PPI clarithromycin 500mg and metronidazole 400mg twice daily versus 10-day concomitant therapy CT twice daily PPI amoxicillin 1g clarithromycin 500mg and metronidazole 400mg as first line treatment for H pylori infection
Patients and Methods
Study Design
Prospective randomized controlled study
Treatment H pylori infected patients will be randomized to be treated using either 10 day TT PPI amoxicillin 1g clarithromycin 500mg twice daily or 10-day ST PPI and amoxicillin 1 g twice daily x 5 days followed by PPI clarithromycin 500mg metronidazole 400mg twice daily x 5days or 10-day CT PPI amoxicillin 1g clarithromycin 500mg metronidazole 400mg twice daily The success of treatment will be defined as either a negative carbon urea breath test CUBT or negative histology performed more than 4 weeks after completion of treatment CUBT or histology will be performed based on the clinical indication as determined by the attending physician All patients should be off PPI for at least 2 weeks or histamine 2 receptor antagonists for at least 1 week prior to assessment of the success of treatment as per standard practice The compliance to treatment in terms of percentage of drugs taken will be assessed during clinic review
Antibiotic susceptibility testing For patients with H pylori infection diagnosed during endoscopy from a positive rapid urease test kit the material from the test kit will be used sent for antibiotic susceptibility testing whenever it is technically feasible This may be of value in guiding the choice of antibiotics for second line salvage treatment should first line treatment fails
Statistical analysis
A treatment success rate of 80 is regarded as the minimum acceptable threshold for empiric first line therapy Data from several countries have suggested that the success rate of triple therapy may be lower than 80 whereas that for concomitant therapy may exceed 90 Thus for the study to have 80 power with significance level of 5 the minimum number of patients to be recruited into each arm will be 138 if the highest success rate is 91 and lowest success rate is 79 Randomization will be performed in blocks of 15 Categorical data will be analysed using Chi-square or Fisher exact test while continuous data will be analysed using students t test A p value of 005 will be taken as statistically significant
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None