Efficacy of esomeprazole 40 mg vs. lansoprazole 30 mg for healing moderate to severe erosive oesophagitis

Abstract

Summary Background : Secondary analyses from previous studies indicated that esomeprazole was more effective than lansoprazole and omeprazole in healing moderate or severe (Los Angeles grades C or D) erosive oesophagitis (EE). Aim : To compare prospectively healing rates with esomeprazole vs. lansoprazole in patients with moderate to severe EE. Methods : In this multicentre, randomized, double‐blind, parallel‐group trial, adult patients with endoscopically confirmed moderate or severe EE received esomeprazole 40 mg (n = 498) or lansoprazole 30 mg (n = 501) once daily for up to 8 weeks. The primary end point was EE healing through week 8. Secondary assessments included investigator‐assessed resolution of symptoms and safety and tolerability. Results : Time to healing was significantly different (P = 0.007), favouring esomeprazole. Estimated healing rates at week 8 were 82.4% with esomeprazole 40 mg and 77.5% with lansoprazole 30 mg. Heartburn resolved at week 4 in 72% and 64% of patients who received esomeprazole and lansoprazole, respectively (P = 0.005). Control of other GERD symptoms was similar between treatments. Both treatments were well tolerated. Conclusions : With 8 weeks’ treatment, esomeprazole 40 mg once daily heals moderate to severe EE faster and in more patients, and resolves heartburn in more patients after 4 weeks of treatment, than lansoprazole 30 mg once daily.

A comparison of esomeprazole and lansoprazole for control of intragastric pH in patients with symptoms of gastro‐oesophageal reflux disease

“…19,20 The primary objective of this study was to compare the effects of once and twice daily dosing of esomeprazole 40 mg and lansoprazole 30 mg on intragastric pH over a 24-hour period in patients with GERD symptoms. This study uses a novel crossover design to evaluate the effects of once and twice daily dosing of two different PPIs.…”

Management of reflux esophagitis: does the choice of proton pump inhibitor matter?

“…Two of the three studies compared the healing efficacy of esomeprazole 40 mg with lansoprazole 30 mg (capsules containing 30 mg of active ingredient) (11,12,19). Of these two studies, one included patients with RE of Los Angeles (LA) classification grade A-D (11,19), while the other included only patients with more severe RE, i.e.…”

“…Three studies evaluating healing of RE after 4-8 weeks of once-daily treatment with esomeprazole 40 mg (esomeprazole magnesium trihydrate 44.5 mg) or a comparator PPI were included (11,12,15,19). In all studies, the primary efficacy end-point was endoscopically-confirmed RE healing at week 8.…”

“…Reasons for exclusion included: non-English language; non-comparative study; absence of endoscopy data; absence of standardised RE grading system; and on-demand rather than continuous treatment. Three healing studies (11,12,15,19) and three maintenance studies (14,16,20) were therefore included in the hypothetical management model.…”

“…Numerous studies have demonstrated the efficacy of PPIs for initial healing of RE (11)(12)(13)(14)(15)(16)(17)(18) and numerous separate studies have demonstrated the efficacy of PPIs for maintaining endoscopic remission (8,10). The EXPO study (14,15), which compared esomeprazole with pantoprazole, is one of the few clinical trials to follow patients with RE through the entire course of management, i.e.…”