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• W2912953093 abstract "A new phase 3 study shows vonoprazan is effective as part of first-line and second-line triple therapy in patients positive for Helicobacter pylori with previous gastric or duodenal ulcer. Of the 650 patients who were randomly assigned to receive vonoprazan in first-line triple therapy (plus amoxicillin 750 mg and clarithromycin 200 mg or 400 mg), 641 completed treatment. The first 50 patients who failed first-line therapy but who had good compliance also received second-line vonoprazan-based triple therapy (plus amoxicillin 750 mg and metronidazole 250 mg). Kazunari Murakami and colleagues confirmed that vonoprazan was non-inferior to lansoprazole. The first-line eradication rate was 92·6% (95% CI 89·2–95·2) for vonoprazan versus 75·9% (70·9–80·5) for lansoprazole (difference 16·7%, 95% CI 11·2–22·1). The second-line eradication rate was also high (98·0%, 95% CI 89·4–99·9). Treatment in either first or second line was well tolerated. Obeticholic acid could be beneficial in patients with primary biliary cholangitis because of its effect on alkaline phosphatase and bilirubin concentrations, which correlate with the risk of liver transplantation or death. Frederik Nevens and colleagues randomly assigned 217 patients to receive obeticholic acid at a dose of 10 mg (n=73) or 5 mg (with adjustment to 10 mg if applicable [5–10 mg group]; n=71), or to receive placebo (n=73). Only patients who had an inadequate response to ursodeoxycholic acid (ursodiol) or who found the side-effects of ursodeoxycholic acid unacceptable were included, and 200 (93%) of the 216 patients in the intention-to-treat population received ursodeoxycholic acid as background therapy. At 12 months, the primary endpoint—an alkaline phosphatase concentration of less than 1·67 times the upper limit of the normal range, with a reduction of at least 15% from baseline, and a normal total bilirubin level—occurred in 46% of patients in the 5–10 mg group, 47% in the 10 mg group, and 10% in the placebo group (p<0·001). Pruritus was the most common adverse event noted with obeticholic acid, occurring in 56% of patients in the 5–10 mg group, 68% of those in the 10 mg group, and 38% of those in the placebo group. Repeat treatment with rifaximin is safe and efficacious in patients with diarrhoea-predominant irritable bowel syndrome (IBS-D), a new open-label study suggests. Anthony Lembo and colleagues included patients with mean abdominal pain and bloating scores of 3 or more and loose stool. Patients responding to a 2-week course of rifaximin at 550 mg three times a day who then relapsed, were randomly assigned to repeat treatments of rifaximin at 550 mg or placebo, three times a day for 2 weeks. Of 1074 patients who responded to rifaximin, 692 (64%) relapsed. 328 of these patients were randomly assigned to receive repeat treatment with rifaximin and 308 to receive placebo. The percentage of responders was significantly greater with rifaximin than placebo (38·1% vs 31·5%, p=0·03). The percentage of responders for abdominal pain was significantly greater with rifaximin than with placebo (50·6% vs 42·2%, p=0·018), but not stool consistency (51·8% vs 50·0%, p=0·42). The use of incretin-based drugs for management of type 2 diabetes is not associated with an increased risk of acute pancreatitis, but the use of GLP-1 analogues is associated with an increased risk of bile duct and gallbladder disease, according to new research. To establish whether the use of incretin-based drugs is associated with an increased risk of acute pancreatitis, Laurent Azoulay and colleagues identified 1 532 513 patients with type 2 diabetes who started using antidiabetic drugs from January, 2007, to June, 2013, and were followed up to June, 2014. Nested case-control analyses showed 5165 patients were admitted to hospital for acute pancreatitis (incidence 1·49 per 1000 person-years). Current use of incretin-based drugs was not associated with an increased risk of acute pancreatitis when compared with current use of two or more oral antidiabetic drugs (pooled adjusted hazard ratio [HR] 1·03; 95% CI 0·87–1·22). Similarly, the risk did not vary by drug class or duration of use. Jean-Luc Faillie and colleagues did a separate population-based cohort study of 71 369 adults with type 2 diabetes mellitus (227 994 person-years of follow-up) identified in the linked UK Clinical Practice Research Datalink and Hospital Episodes Statistics database. 853 patients were admitted to hospital for bile duct and gallbladder disease (incidence 3·7 per 1000 person-years; 95% CI 3·5–4·0). DPP-4 inhibitors were not associated with an increased risk for bile duct and gallbladder disease compared with current use of at least two oral antidiabetic drugs (3·6 vs 3·3 per 1000 person-years; adjusted HR 0·99; 95% CI 0·75–1·32), but GLP-1 analogues were (6·1 vs 3·3 per 1000 person-years; adjusted HR 1·79; 95% CI 1·21–2·67). For the vonoprazan Helicobacter pylori study see Gut 2016; published online March 2. https://dx.doi.org/10.1136/gutjnl-2015-311304For the obeticholic acid study see N Engl J Med 2016; published online Aug 18. https://dx.doi.org/10.1056/NEJMoa1509840For the rifaximin IBS-D study see Gastroenterol 2016; published online Aug 13. https://dx.doi.org/10.1053/j.gastro.2016.08.003For Azoulay and colleagues' study see JAMA Intern Med 2016; published online Aug 1. https://dx.doi.org/10.1001/jamainternmed.2016.1522For Faillie and colleagues' study see JAMA Intern Med 2016; published online Aug 1. https://dx.doi.org/10.1001/jamainternmed.2016.1531 For the vonoprazan Helicobacter pylori study see Gut 2016; published online March 2. https://dx.doi.org/10.1136/gutjnl-2015-311304 For the obeticholic acid study see N Engl J Med 2016; published online Aug 18. https://dx.doi.org/10.1056/NEJMoa1509840 For the rifaximin IBS-D study see Gastroenterol 2016; published online Aug 13. https://dx.doi.org/10.1053/j.gastro.2016.08.003 For Azoulay and colleagues' study see JAMA Intern Med 2016; published online Aug 1. https://dx.doi.org/10.1001/jamainternmed.2016.1522 For Faillie and colleagues' study see JAMA Intern Med 2016; published online Aug 1. https://dx.doi.org/10.1001/jamainternmed.2016.1531" @default.
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• W2912953093 title "Research in brief" @default.
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