UNASSIGNED: Patients who failed twice or more PPI-based triple therapies were recruited. Patients underwent CYP2C19 genotype and antibiotic susceptibility tests (ASTs). PPI doses per day were decided as per the CYP2C19 genotype: twice for poor and 4 times for extensive metabolizers (dimension 1). Two antibiotics were selected as per the results of the AST in each patient (dimension 2). Regimens of 2dTMT included 2 susceptible antibiotics and a PPI. For those who could not have enough information with the AST, tailor-made PPI dosing was indicated with empirically selected 2 antibiotics (one-dimension tailor-made therapy [1dTMT]).
UNASSIGNED: Of 51 candidates with multiple eradication failures, 37 patients underwent the genotype test and AST, and 24 succeeded to obtain sufficient information to select 2 susceptible antibiotics. Of them, 22 patients accepted to receive 14-day 2dTMT. Of the residual patients, 12 accepted to receive 14-day 1dTMT. The mean eradication rate of 2dTMT was 86.4% (95% confidence interval [CI]: 65.1%-98.8%) in intention-to-treat and 90.5% (95% CI: 69.6%-98.8%) in per-protocol analyses, whereas that of 1dTMT was 75.0% (95% CI: 42.8%-94.5%) in intention-to-treat and 90.0% (95% CI: 55.5%-99.7%) in per-protocol analyses.
UNASSIGNED: Without vonoprazan, 14-day 2dTMT could be one of the salvage therapies for patients with multiple eradication failures. In cases of insufficient information with the AST, 14-day 1dTMT could be an alternative therapy. Clinical Trials Registry number, UMIN000022154 (https://www.umin.ac.jp/icdr/index.html).
■招募两次或更多次基于PPI的三联疗法失败的患者。患者接受CYP2C19基因型和抗生素敏感性试验(AST)。根据CYP2C19基因型决定每天的PPI剂量:不良代谢者两次,广泛代谢者4次(维度1)。根据每个患者的AST结果选择两种抗生素(维度2)。2dTMT方案包括2种敏感抗生素和PPI。对于那些无法获得足够信息的人,根据经验选择的2种抗生素(一维定制治疗[1dTMT])表明了定制的PPI给药.
■在多次根除失败的51个候选人中,37例患者接受了基因型测试和AST,24成功获得了足够的信息来选择2种敏感抗生素。其中,22名患者接受14天2dTMT。残余病人中,12接受接受14天1dTMT。意向治疗中2dTMT的平均根除率为86.4%(95%置信区间[CI]:65.1%-98.8%),符合方案分析中2dTMT的平均根除率为90.5%(95%CI:69.6%-98.8%)。而1dTMT在意向治疗分析中为75.0%(95%CI:42.8%-94.5%),在符合方案分析中为90.0%(95%CI:55.5%-99.7%).
■没有vonoprazan,14天2dTMT可能是多次根除失败患者的挽救疗法之一。在AST信息不足的情况下,14天1dTMT可能是一种替代疗法。临床试验登记号,UMIN000022154(https://www.乌明。AC.jp/icdr/index。html).