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| |  UEGW: Esomeprazole Provides Longer and Better Intragastric Acid Control Than Lansoprazole By Adrian Burton MADRID, SPAIN -- November 6, 2003 -- A Swiss study has shown that esomeprazole 40 mg provides longer and better intragastric acid control than any of a 15-60 mg range of doses of lansoprazole. These findings should help people who suffer from acid-reflux oesophagitis by allowing their doctors to better prescribe the doses they should take. Esomeprazole 20 mg and 40 mg and lansoprazole 15 mg and 30 mg are the approved doses for the treatment of gastro-oesophageal reflux disease. Both drugs help patients maintain a higher intragastric pH and therefore reduce reflux damage, but doctors often raise these doses if the results obtained are not those hoped for. The question is, does this actually do any good? To find out, Clive Wilder-Smith, MD, of the gastrointestinal unit and GI physiology laboratory, Gastroenterology Group Practice, Bern, Switzerland, looked at the maintenance of pH with different doses of the two drugs. He presented his findings here November 4th at the 11th United European Gastroenterology Week. "pH studies are based on a good correlation between [maintaining] a pH threshold of above 4 and the healing of oesophagitis," explained Dr. Wilder Smith. "If we raise the pH above 4 reliably -- and the longer the better – then that predicts the healing results quite nicely in oesophagitis patients." In a randomised, six-way, crossover study, 37 patients received esomeprazole 20, 40 and 80 mg or lansoprazole 15, 30 and 60 mg once daily before breakfast for five days (washout of 13 days between drugs and doses). Intragastric pH was then monitored over 24 hours on day 5 of each treatment using a glass electrode, and the length of time patients' pH was above the threshold of 4 was recorded. At the lower doses, esomeprazole 20 mg provided longer acid control than lansoprazole 15 mg (11.2 hours above pH 4 compared to 8.5 hours; P = .0001), and similar control to lansoprazole 30 mg (11.3 hours compared to 10.8 hours; P = .4). Significantly longer acid control was also obtained with esomeprazole 40 mg than lansoprazole 30 mg (14.7 hours above pH 4 compared to 11.0 hours; P < .0001) or 60 mg (14.7 hours compared to 12.4 hours; P < .0001). Esomeprazole 80 mg also provided greater acid control than lansoprazole 60 mg (15.8 hours compared to 12.4 hours; P < .0001). However, the length of time this esomeprazole dose maintained the pH above 4 was not significantly longer than that achieved by the 40 mg dose – showing the latter to be the lowest dose for the best pH controlling effect. Further, effective (symptom relieving) acid control was achieved in over 80% more patients with esomeprazole 40 mg than with lansoprazole 30 mg or even 60 mg (P < .001). "Without this head-to-head analysis, [a doctor would not know which] drug to use with patients," explained Dr. Wilder-Smith. "This makes it easy for clinicians to sort out the doses. The message here is that doctors should begin with esomeprazole 40 mg."
[Study title: Comparison of Esomeprazole 20, 40, 80 mg Versus Lansoprazole 15, 30, 60 mg on Intragastric pH in Health Subjects. Abstract Tue-G-022]
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