Esomeprazole 20 mg and lansoprazole 15 mg in maintaining healed reflux oesophagitis: Metropole study results

Abstract

Introduction: Esomeprazole, the first proton pump inhibitor to be developed as an optical isomer, has demonstrated more effective healing vs. omeprazole and lansoprazole in patients with reflux oesophagitis (RO). However, RO recurs in a high proportion (80%) of these patients within 12 months of initial therapy, highlighting the importance of maintenance treatment. Previous studies have shown esomeprazole to be effective as maintenance therapy in healed RO patients. RO and ⁄ or discontinuation due to symptom recurrence) was analysed using a log-rank test. Results: Esomeprazole maintained a significantly higher proportion of patients in remission than lansoprazole over the 6-month course of treatment (P < 0.0001, intention-to-treat analysis). After 6 months' treatment, 83% of esomeprazole recipients were in remission compared with 74% of lansoprazole recipients (life-table estimates). Esomeprazole gave a longer time to relapse than lansoprazole irrespective of baseline LA Grade, significantly so for baseline LA Grades B, C and D (P < 0.05 for each comparison). Significantly more patients were free from heartburn in the esomeprazole group compared with the lansoprazole group at 1, 3 and 6 months (P < 0.05). Significant differences at 6 months between esomeprazole 20 mg o.d. and lansoprazole 15 mg o.d. were also observed for control of epigastric pain and acid regurgitation (P < 0.05 and P < 0.001, respectively). Both treatment regimens were well tolerated. Conclusion: Esomeprazole 20 mg o.d. is a more effective maintenance treatment than lansoprazole 15 mg o.d. for symptom-free patients with healed RO.ACKNOWLEDGEMENT

Esomeprazole in acute and maintenance treatment of reflux oesophagitis: a multicentre prospective study

“…The major limitation of our study is the lack of a comparator arm and the openlabel aspect of the trial design. [27][28][29][30] There is limited and controversial evidence that the presence of H. pylori infection may protect against GERD. 31 A recent systematic review confirmed that the prevalence of H. pylori infection is lower in patients with GERD than in those without the disease.…”

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Short and long-term PPI treatment for GERD. Do we need more-potent anti-secretory drugs?

“…However some studies suggest that a standard dose PPI could be more effective and less costly for the maintenance of management of GERD [77]. According to a large, randomized study [78] esomeprazole 20 mg is more effective than lansoprazole 15 mg in maintaining remission independently of disease severity.…”