Triple therapy comparative studies

The presence of a defective CYP2C19 allele has been associated with improved Helicobacter pylori cure rates after dual (omeprazole and amoxicillin) or triple therapy (omeprazole, amoxicillin, and clarithromycin) with omeprazole, as weU as with lansoprazole. This difference likely reflects the higher achievable intragastric pH in the PM group. The cure rate achieved with dual therapy was 100% in PMs compared with 60% and 29% in heterozygous and homozygous EMs, respectively. In two studies, EMs had H. pylori... 

H. pylori [269]. Multiple studies investigating azithromycin in combination with one or two other drugs (amoxicillin, metronidazole, tinidazole, tetracycline, bismuth subsalicylate, and/or a PPl) revealed that the more effective azithromycin-containing regimens involved triple therapy [270-275]. In contrast to clarithromycin, azithromycin is not FDA approved for treatment of H. pylori disease. The role of azithromycin in the treatment of H. pylori remains to be defined. Several in vitro and animal studies have suggested that azithromycin may be clinically active in the treatment of early Lyme disease (LD) [276-278], Several clinical trials of treatment of early Lyme disease performed in the United States and Europe comparing azithromycin vs. doxycycline, oral penicillin, amoxicilUn/ probenicid, or oral amoxicillin revealed no significant difference in clinical outcome [279-283]. The precise role and dose of azithromycin in the treatment of early LD remains to be established. 

The SPRINT-2 study demonstrated that the addition of boceprevir significantly increased the SVR rates compared to PR alone (PR48) (63-66% SVR in triple therapy arms vs. 38% in PR48 control). No significant difference in SVR rates was observed between the 24-week versus 44-week boceprevir dosing arms. 

The discovery and development efforts that led to successful approval of boceprevir and telaprevir have produced tangible benefits to HCV patients worldwide. Meta-analyses designed to compare the efficacy and safety of boceprevir and telaprevir have been reported. Cooper and coworkers concluded that boceprevir and telaprevir appear comparable in terms of SVR, relapse, or discontinuation of therapy for patients treated under standard or response-guided therapy durations. In a separate analysis, Sitole and co-workers concluded that the triple therapies utilizing either boceprevir or telaprevir for HCV genotype 1 infection resulted in more patients reaching SVR but also in more drug-related adverse events. Additionally, this study noted that short-term treatment response... 

Misiewicz JJ, Harris AW, Bardhan KD, et al. One week triple therapy for Helicobacter pylori a multicentre comparative study. Lansoprazole Helicobacter Study Group. Gut 1997 41 735-739. 

A meta-analysis of eight studies that compared 24- and 48-week sustained viral responses (SVR) and drug-related adverse events between telaprevir (5 studies) and boceprevir (3 studies involving 2020 patients) triple-therapy regimens in the treatment of chronic HCV infection, also reported increased prevalence of anaemia and dysgeusia associated with boceprevir [70 ]. It was calculated that treating 100 (naive or experienced) HCV patients with boceprevir-based triple therapy would result in 21 additional instances of anaemia and 26 of dysgeusia linked to treatment. 

Lee KJ, Kim JH, Hahm KB et al (2000) Randomized trial of N-Butyl-2-Cyanoacrylate compared with injection of hypertonic saline-epinephrine in endoscopic treatment of bleeding peptic ulcers. Endoscopy 32 505-511 Lin CK, Lai KH, Lo GH et al (1996) The value of second-look endoscopy after endoscopic injection therapy for bleeding peptic ulcer. Gastroenterology 110 A-117 Lind T, M graud F, Unge P et al (1999) The MACH2 study role of omeprazole in eradication of Helicobacter pylori with 1-week triple therapies. Gastroenterology 116 248-253... 

The potency and effectiveness of TAC have prompted studies to investigate withdrawal of corticosteroids or other concomitant immunosuppressants. A large randomized, controlled trial compared triple-drug therapy, consisting of TAC, corticosteroids, and mycophe-nolate mofetil, with early withdrawal of corticosteroids or mycophe-nolate in kidney transplant recipients. The results demonstrated equal efficacy in the three arms with no difference in acute rejection rates after 6 months of therapy. Furthermore, TAC has demonstrated equal efficacy to CSA, each in combination with azathioprine, with regard to corticosteroid withdrawal. ... 

Metallic stents were compared with laser therapy in a prospective triple-randomized study. A total of 60 patients with unresectable tumors were randomized to treatment with endoscopic laser therapy (18 patients), covered Wallstent endoprostheses (23 patients), and uncovered Strecker stents (19 patients). Both types of stents produced significantly better dysphagia relief than laser therapy (p<0.02) (Adam et al 1997). 

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