Adjuvant simvastatin may improve H. pylori eradication with triple therapy
Adding simvastatin as an adjuvant to standard triple therapy in Helicobacter pylori treatment may help compensate for increasing antimicrobial resistance, according to a new study.
In a randomized controlled trial at Al-Azhar-Assiut University Hospital, Egypt, enrolling 100 patients of mean age 35.5±12.9 years (29 men, 71 women) with H. pylori infection confirmed by stool antigen test (SAT), researchers found that the addition of simvastatin twice daily to standard triple therapy for H. pylori improved the eradication rate from 62 to 82 percent. [Infect Drug Resist 2019;12:1529–1534]
“This result agrees with the study by Nseir et al, in which the addition of [a] statin to the standard triple therapy increased the eradication rate of H. pylori infection from 72 to 91 percent,” said the researchers. [Aliment Pharmacol Ther 2012;36:231–238]
Patients were randomized in two groups, with the first (n=50) receiving the standard triple therapy of clarithromycin 500 mg twice daily, amoxicillin 1,000 mg twice daily, and omeprazole 20 mg. The second group (n=50) received triple therapy plus simvastatin 20 mg twice daily (n=50) throughout a 14-day period. H. pylori eradication was assessed by SAT 4 weeks after the end of treatment.
Four weeks after treatment, eradication of H. pylori infection was confirmed in 41 patients in the adjuvant group versus 31 in the standard therapy group (p=0.022). All patients enrolled in the study were reportedly compliant and adherent to treatment.
Minor adverse effects including headache, epigastric pain, nausea, and diarrhoea were reported with no significant difference between the two groups.
Due to increasing antimicrobial resistance, H. pylori eradication rates using standard triple therapy have fallen below 80 percent in many parts of the world; as such, it is no longer preferred as a first-line therapy in areas with high clarithromycin resistance. Yet, alternative or adjunct drugs could help bring standard triple therapy’s eradication rates back above the 80 percent threshold for consideration as a first-line therapy, said the researchers. [Panminerva Med 2016;58(4):304–317; Gastroenterol Res Pract. 2012;doi:10.1155/2012/168361]
They added that simvastatin was chosen for their investigation as previous studies had demonstrated its potential direct antibacterial effects, synergistic activity with antibiotics, and immune system stimulation. [EJGG 2015;2(1):19–26]
“Simvastatin also promotes lysosomal fusion, resulting in degradation of sequestered bacteria, and in turn attenuates interleukin-1β production,” said the researchers. “In addition, Lai et al showed that depletion of cholesterol can attenuate CagA-induced pathogenesis. On this basis, the present study was conducted to investigate the value of adding simvastatin as an adjuvant to [the standard treatment].” [Front Cell Infect Microbiol 2017;6:203; Infect Immun 2008;76:3293–3303]
The authors noted that the Egypt study was limited by the small number of patients and their enrolment from a single centre, adding that further multicentre randomized clinical trials would be needed to verify simvastatin’s efficacy and safety as a part of H. pylori treatment.