Direct comparative trials of the efficacy of proton pump inhibitors in the management of gastro‐oesophageal reflux disease and peptic ulcer disease

Abstract

Summary Background : Five proton pump inhibitors are now available for use in North America. Claims of differences in the clinical efficacy of different strengths and/or agents have been made. Aim : To identify any consistent evidence of differences in outcomes between agents or doses within this class of drugs. Methods : A search of the medical literature was performed in two electronic databases, and randomized controlled trials of higher quality were included in the assessment. Results and conclusions : Thirty‐two trials met our criteria. No convincing data were found to indicate that low doses of proton pump inhibitors are as effective as standard doses of proton pump inhibitors in the healing of erosive oesophagitis or in the relief of symptoms of gastro‐oesophageal reflux disease; however, they may be as effective as maintenance therapy for gastro‐oesophageal reflux disease and peptic ulcer disease. Differences were found between the standard doses of proton pump inhibitors with regard to the onset of symptom relief in gastro‐oesophageal reflux disease (lansoprazole was faster than omeprazole, and esomeprazole was faster than both lansoprazole and omeprazole) and the healing of oesophagitis (esomeprazole was superior to both omeprazole and lansoprazole). Despite these differences, there are as yet insufficient data to establish the superiority of any one agent over all others across all disease states treated with these agents.

Five-Year Examination of Utilization and Drug Cost Outcomes Associated with Benefit Design Changes Including Reference Pricing for Proton Pump Inhibitors in a State Employee Health Plan

“…[4][5][6][7] The literature review showed that the PPIs are a particularly well-tolerated class of drugs. Using this evidence, the DUEC concluded that all PPIs were therapeutically equivalent in efficacy and safety.…”

Practical considerations in the management of proton-pump inhibitors

“…In the maintenance treatment of peptic ulcer it has been found that low doses of PPI have similar effects to standard doses (79). In healing rates of ulcers there are not statistically significant differences between omeprazole, pantoprazole, lansoprazole and rabeprazole (80).…”

“…Low doses of PPI compared with standard doses are not equally effective in healing erosive esophagitis or symptomatic GERD (79). However, in maintenance treatment of GERD there is similar efficacy.…”

Treatment of uncomplicated reflux disease

“…There is a linear relationship between the degree of acid suppression measured by the time per day that gastric pH is higher than 4, and the healing kinetics of esophagitis [49] . With regard to the healing rates of reflux esophagitis after 4 and 8 wk, no differences are to be seen between the standard doses of the racemic PPIs (omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, rabeprazole 20 mg) [46,47] , nor did doubling the individual dose (e.g. lansoprazole 60 mg, pantoprazole 80 mg) increases efficacy.…”

“…Racemic PPIs (omeprazole, lansoprazole, pantoprazole, rabeprazole) differ in such pharmacokinetic characteristics as bioavailability and the rapidity with which an effect occurs. This, however, is irrelevant for the healing of esophagitis at 4 and 8 wk [46,47] , although the substances do differ in terms of the time required to eliminate symptoms. In a large randomized, controlled study involving more than 3 500 patients with erosive esophagitis, lansoprazole 30 mg o.d.…”