A 5-Way Comparison of Proton-Pump Inhibitors

Journal Watch. 2004;3(1) 

Introduction

Although 5 proton-pump inhibitors (PPIs) are available in the U.S., no 5-way studies have compared their efficacy in relieving symptoms of gastroesophageal reflux. In this randomized, open-label, crossover study, researchers compared short-term gastric acid control with each of the 5 drugs. Sources of financial support are not mentioned in the article, but at least one author is employed by the manufacturer of esomeprazole and omeprazole.

Thirty-four patients with frequent heartburn received 5-day oral courses (separated by 10-day washout periods) of PPIs; each one was taken at the standard recommended daily dose (esomeprazole, 40 mg; lansoprazole, 30 mg; omeprazole, 20 mg; pantoprazole, 40 mg; and rabeprazole, 20 mg). On day 5 of each treatment course, patients underwent 24-hour intragastric pH monitoring. The mean percentage of time with intragastric pH above 4.0 was significantly higher for esomeprazole (58%) than for any of the other 4 drugs (range, 42%-51%).

In this short-term study, esomeprazole suppressed gastric acid secretion for a larger proportion of the day than did the other 4 drugs. However, the clinical significance of this observation is unclear: In some, but not all, 2-way comparisons with other PPIs, esomeprazole has relieved symptoms or healed erosions slightly more effectively than the comparison PPI. A recent systematic review summarized the mostly 2-way comparative PPI trials that were published from 1988 through 2002 (Aliment Pharmacol Ther 2003; 18:559). Until one drug is shown to be clinically superior for most patients, it seems reasonable to base initial PPI choices on cost.

— Allan S. Brett, MD

Miner P et al. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: A five-way crossover study. Am J Gastroenterol 2003 Dec; 98:2616-20.

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