Prevention of erosive oesophagitis relapse with pantoprazole

Abstract

SUMMARY Aim:1To compare the safety and efficacy of pantoprazole and ranitidine in maintaining erosive oesophagitis healing. Methods: Gastro-oesophageal reflux disease patients (349) with endoscopically documented healed erosive oesophagitis (grade 0 or 1) were randomly assigned to receive pantoprazole (10, 20 or 40 mg/q.d.s.) or ranitidine (150 mg/b.d.). Erosive oesophagitis status was assessed endoscopically at months 1, 3, 6 and 12 or when relapse symptoms appeared (relapse ¼ reappearance of erosive oesophagitis grade 2 within 12 months). Symptom-free days were also assessed. Results: Pantoprazole 20-and 40-mg were significantly more effective than ranitidine in maintaining healing regardless of initial erosive oesophagitis grade.Response was dose-related. After 12 months 78, 55, 46 and 21% of patients remained healed (40-, 20-, 10-mg pantoprazole and ranitidine). Pantoprazole 40-mg produced significantly more symptom-free days (83%) than ranitidine (58%). Heartburn-free days/ nights were significantly higher with pantoprazole 40-mg (92 and 93%) than ranitidine (73 and 77%). The most frequent reason for discontinuation, unsatisfactory efficacy, occurred most often with ranitidine (P < 0.001). Conclusion: Once-daily pantoprazole therapy prevented relapse of healed erosive oesophagitis more effectively than ranitidine and with fewer heartburn days. Response to pantoprazole was dose-related. Pantoprazole 40-mg was the most effective regimen and consistent in maintaining erosive oesophagitis healing with a good safety and tolerability profile.

Lansoprazole for Long-Term Maintenance Therapy of Erosive Esophagitis: Double-Blind Comparison with Ranitidine

“…In addition, lansoprazole prevents the recurrence of esophagitis in most patients, regardless of the degree of erosion prior to healing [20]. Other PPIs have also been compared with ranitidine as a long-term maintenance therapy for EE and, as in the current study, when administered at FDA-approved doses for maintenance therapy, they have produced significantly higher remission rates than ranitidine [21,22].…”

Medical treatment of gastroesophageal reflux disease

“…rates (7,18,24). In the study by Richter et al (7), after one-year maintenance treatment with pantoprazole at the standard dose, the endoscopic recurrence rate was found to be 22%.…”

“…In the studies on pantoprazole, a dose of 40 mg/day was found to be superior to a dose of 20 mg/day, while a dose of 80 mg/day was found to be more effective than doses of 40 mg/day and 20 mg/day (7,8). Richter et al (7) compared 173 patients using pantoprazole 40 mg/day with 174 patients using pantoprazole 20 mg/ day.…”

Treatment of uncomplicated reflux disease

“…However, since GERD is usually not progressive, attempts to realize on-demand treatment does not appear to harm the patients [3] . For the prevention of relapse in patients with healed esophagitis, PPIs are clearly superior to H 2 -receptor antagonists, prokinetic drugs and combinations of these medications [67][68][69] . The yield between a standard dose of a PPI and one-half of this dose is, in individual studies, often small, although significant, and even probably clinically relevant differences have occasionally been observed [67] .…”

“…For the prevention of relapse in patients with healed esophagitis, PPIs are clearly superior to H 2 -receptor antagonists, prokinetic drugs and combinations of these medications [67][68][69] . The yield between a standard dose of a PPI and one-half of this dose is, in individual studies, often small, although significant, and even probably clinically relevant differences have occasionally been observed [67] . On the basis of a cost effectiveness analysis using a Markov model designed to simulate the economic and clinical outcomes of GERD in relation to the cost per symptom-free patient years gained and the cost per QALY gained treatment with a standard dose of a PPI appears to be superior despite the higher drug costs [69] .…”