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| |  ASHP: Esomeprazole Reduces Intragastric Acid More Effectively than Other PPIs By Paula Moyer SAN DIEGO, CA -- June 9, 2003 -- Patients who use the proton pump inhibitor (PPI) esomeprazole (Nexium) have less intragastric acidity than those who use other PPIs, according to researchers. "This is the first 5-way comparison crossover study among PPIs," said Al Roach, PharmD, a senior medical information scientist at AstraZenica LP in Wilmington, Delaware, United States. "These findings may be useful when physicians are seeking an effective strategy for acid control in patients with gastroesophageal reflux disease [GERD]." He presented his and his colleagues' findings here June 1st at the American Society of Health-System Pharmacists. Dr. Roache said that the most effective way to assess the pharmacodynamics of PPIs is by measuring intragastric acid suppression. Therefore, he and his colleagues sought to compare the effect of standard doses of esomeprazole versus omeprazole, lansoprazole, pantoprazole, and rabeprazole by examining patients' intragastric pH over a 24-hour period at steady state. This study, designed as a randomised open-label comparative 5-way crossover, involved 44 patients: 26 women and 18 men. All patients had confirmed symptoms of GERD. The investigators evaluated the intragastric pH profile following 5 days of once-daily oral esomeprazole at the standard 40 mg daily dose, then 5 days each of 20 mg of rabeprazole, 30 mg of lansoprazole, 20 mg of omeprazole, or 40 mg of pantoprazole. All patients were negative for Helicobacter pylori and had symptoms of GERD. For 5 consecutive mornings, the patients took the study drug 30 minutes prior to a standardised breakfast. Between each treatment period, patients underwent a 10- to 17-day washout phase. The investigators assessed the participants' mean 24-hour intragastric pH at day 5 after each treatment, including 95% confidence intervals (CI) evaluated. For the 34 evaluable patients, the mean 24-hour intragastric pH was 4.0 when treated with esomeprazole, 3.8 for rabeprazole, omeprazole and lansoprazole each, and 3.6 for pantoprazole. These findings showed that esomeprazole controlled intragastric acid more effectively than the other PPIs investigated, said Dr. Roach ( p<0.01 for rabeprazole, p <0.001 for lansoprazole, omeprazole, and pantoprazole). He said that esomeprazole also was associated with a higher number of hours per day on day 5 in which subjects had a mean pH of >4.0 than were the other PPIs (p<0.0001 in comparison to omeprazole, lansoprazole, and pantoprazole; p<0.001 in comparison to rabeprazole).
[Study title: Esomeprazole 40 mg Provides More Effective Intragastric Acid Control At Steady State Than Standard Doses Of All Other Proton Pump Inhibitors. Abstract T P-28E]
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