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Standard doses of the oral proton pump inhibitors are clinically equivalent: A comparison

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Current GERD Reports

Abstract

Five proton pump inhibitors (PPIs)—esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole—are currently marketed throughout the world. As a therapeutic group, the PPIs are highly useful for the relief of symptoms and healing of gastroesophageal reflux disease (GERD), gastric and duodenal ulcer disease, eradication of Helicobacter pylori infection, prevention and treatment of damage associated with use of NSAIDs, management of hypersecretory states such as Zollinger-Ellison syndrome, and care of patients with nonvariceal upper gastrointestinal bleeding or nonulcer dyspepsia. The pathophysiologic basis of these benefits lies in the PPIs’ potent inhibitory effects on gastric acid. The PPIs differ in pharmacokinetics, pharmacodynamics, interactions with food and antacids, clinical efficacy, and potential for drug interactions. These variations are often subtle and it is not always clear whether they are clinically important. The differences do not appear to be clinically important with regard to symptom response or healing rates in persons with GERD. The choice of one PPI over another must depend on each physician’s interpretation of the clinical importance of these differences, each drug’s approval for treatment of specific clinical indications within the physician’s practice jurisdiction, the strength of the evidence based on clinical trials, and the cost of each PPI.

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References and Recommended Reading

  1. Howden CW: Review article: immediate-release proton-pump inhibitor therapy—potential advantages. Aliment Pharmacol Ther 2005, 22(suppl 3):25–30.

    Article  PubMed  CAS  Google Scholar 

  2. Thomson ABR: Are the orally administered proton pump inhibitors equivalent? A comparison of lansoprazole, omeprazole, pantoprazole, and rabeprazole. Curr Gastroenterol Rep 2000, 2:482–493.

    Article  PubMed  CAS  Google Scholar 

  3. Burget DW, Chiverton SG, Hunt RH: Is there an optimal degree of acid suppression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression. Gastroenterology 1990, 99:345–351.

    PubMed  CAS  Google Scholar 

  4. Bell NJ, Hunt RH: Role of gastric acid suppression in the treatment of gastro-oesophageal reflux disease. Gut 1992, 33:118–124.

    Article  PubMed  CAS  Google Scholar 

  5. Kromer W, Horbach S, Luhmann R: Relative efficacies of gastric proton pump inhibitors: their clinical and pharmacological basis. Pharmacology 1999, 59:57–77.

    Article  PubMed  CAS  Google Scholar 

  6. Tolman KG, Sanders SW, Buchi KN: Gastric pH levels after 15 mg and 30 mg lansoprazole or 20 mg omeprazole [abstract]. Gastroenterology 1994, 106:A172.

    Google Scholar 

  7. Seensalu R, Iwarzon M, Haczewska. I: Dose-response comparison of lansoprazole and omeprazole on 24-hour gastric acidity and plasma gastrin in healthy volunteers [abstract]. Gastroenterology 1995, 108:A215.

    Article  Google Scholar 

  8. Verdu EF, Fraser R, Armstrong D, Blum AL: Lansoprazole and omeprazole at therapeutic doses, produce equivalent rises in gastric pH in Helicobacter pylori (Hp) positive subjects [abstract]. Gastroenterology 1994, 106:A205

    Google Scholar 

  9. Geus WP, Mulder PG, Nicolai JJ, et al.: Acid-inhibitory effects of omeprazole and lansoprazole in Helicobacter pylori-negative healthy subjects. Aliment Pharmacol Ther 1998, 12:329–335.

    Article  PubMed  CAS  Google Scholar 

  10. Dammann HG, Fuchs W, Richter G, et al.: Lansoprazole versus omeprazole: influence on meal-stimulated gastric acid secretion. Aliment Pharmacol Ther 1997, 11:359–364.

    Article  PubMed  CAS  Google Scholar 

  11. Huang J, Goldwater D, Thomson A, et al.: Lansoprazole achieves faster control of intragastric acidity than pantoprazole [abstract]. Gut 1999, 45:A102.

    Article  Google Scholar 

  12. Meyer UA: Metabolic interactions of the proton-pump inhibitors lansoprazole, omeprazole and pantoprazole with other drugs. Eur J Gastroenterol Hepatol 1996, 8(suppl 1):S21–S25.

    Article  PubMed  Google Scholar 

  13. Canadian Agency for Drugs and Technologies in Health (CADTH): Evidence for PPI use in gastroesophageal reflux disease, dyspepsia and peptic ulcer disease (draft). 2007. Available at http://www.cadth.ca/media/compus/pdf/Draft_Scientific_Report_Evidence_PPI_GERD_e.pdf. Accessed September 27, 2007.

  14. Donnellan C, Sharma N, Preston C, Moayyedi P: Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev 2005, CD003245.

  15. Edwards SJ, Lind T, Lundell L: Systematic review of proton pump inhibitors for the maintenance of healed reflux oesophagitis. J Drug Assess 2002, 5:165–178.

    Google Scholar 

  16. McDonagh MS, Carson S: Drug Class Review on Proton Pump Inhibitors: Final Report Update 3. Portland: Oregon Health and Science University; 2005.

    Google Scholar 

  17. Edwards SJ, Lind T, Lundell L: Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis. Aliment Pharmacol Ther 2001, 15:1729–1736.

    Article  PubMed  CAS  Google Scholar 

  18. Vakil NJ, Fennerty MB: Direct comparative trials of the efficacy of proton pump inhibitors in the management of gastro-oesophageal reflux disease and peptic ulcer disease. Aliment Pharmacol Ther 2003, 18:559–568.

    Article  PubMed  CAS  Google Scholar 

  19. Wang W, Huang J, Zheng G, et al.: Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis. World J Gastroenterol 2005, 11:4067–4077.

    PubMed  CAS  Google Scholar 

  20. McQuaid KR, Laine L: Early heartburn relief with proton pump inhibitors: a systematic review and meta-analysis of clinical trials. Clin Gastroenterol Hepatol 2005, 3:553–563.

    Article  PubMed  CAS  Google Scholar 

  21. Klok RM, Postma MJ, van Hout BA, Brouwers JR: Meta-analysis: comparing the efficacy of proton pump inhibitors in short-term use. Aliment Pharmacol Ther 2003, 17:1237–1245.

    Article  PubMed  CAS  Google Scholar 

  22. Mönnikes H, Pfaffenberger B, Gatz G, et al.: Novel measurement of rapid treatment success with ReQuest: first and sustained symptom relief as outcome parameters in patients with endoscopy-negative GERD receiving 20 mg pantoprazole or 20 mg esomeprazole. Digestion 2005, 71:152–158.

    Article  PubMed  Google Scholar 

  23. Chen C, Lu C, Luo J, et al.: Esomeprazole tablet vs omeprazole capsule in treating erosive esophagitis. World J Gastroenterol 2005, 11:3112–3117.

    PubMed  CAS  Google Scholar 

  24. Fock KM, Teo EK, Ang TL, et al.: Rabeprazole vs esomeprazole in non-erosive gastro-oesophageal reflux disease: a randomized, double-blind study in urban Asia. World J Gastroenterol 2005, 11:3091–3098.

    PubMed  CAS  Google Scholar 

  25. Armstrong D, Talley, NJ, Lauritsen K, et al.: The role of acid suppression in patients with endoscopy-negative reflux disease: the effect of treatment with esomeprazole or omeprazole. Aliment Pharmacol Ther 2004, 20:413–421.

    Article  PubMed  CAS  Google Scholar 

  26. Chey W, Huang B, Jackson RL: Lansoprazole and esomeprazole in symptomatic GERD: a double-blind, randomized, multicentre trial in 3000 patients confirms comparable symptom relief. Clin Drug Invest 2003, 23:69–84.

    Article  CAS  Google Scholar 

  27. Vcev A, Stimac D, Vceva A, et al.: Pantoprazole versus omeprazole in the treatment of reflux esophagitis. Acta Med Croatica 1999, 53:79–82.

    PubMed  CAS  Google Scholar 

  28. Vicari F, Belin J, Marek L: Pantoprazole 40 mg versus omeprazole 20 mg in the treatment of reflux esophagitis: results of a French multicentric double-blind comparative trial [abstract]. Gastroenterology 1998, 114:G1324.

    Google Scholar 

  29. Mössner J, Koop H, Porst H: One-year prophylactic efficacy and safety of pantoprazole in healed reflux oesophagitis [abstract]. Gut 1996, 39:A602.

    Google Scholar 

  30. Van Rensburg CJ, Honiball PJ, Gundling HDK: Prophylactic efficacy and safety of 40 mg pantoprazole against relapse in patients with healed reflux oesophagitis: a two-year study [abstract]. Gut 1996, 39:A603.

    Google Scholar 

  31. Lauritsen K, Jaup B, Carling L, et al.: Efficacy of pantoprazole compared with omeprazole in prevention of relapse of reflux esophagitis: double blind randomized multicentre trial [abstract]. Gastroenterology 2000, 118:A1290.

    Article  Google Scholar 

  32. Stanghellini V, Armstrong D, Mönnikes H, et al.: Determination of ReQuest-based symptom thresholds to define symptom relief in GERD clinical studies. Digestion 2005, 71:145–151.

    Article  PubMed  Google Scholar 

  33. Armstrong D, Mönnikes H, Bardhan KD, Stanghellini V: The construction of a new evaluative GERD questionnaire—methods and state of the art. Digestion 2004, 70:71–78.

    Article  PubMed  Google Scholar 

  34. Bardhan KD, Stanghellini V, Armstrong D, et al.: Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest. Digestion 2004, 69:229–237.

    Article  PubMed  CAS  Google Scholar 

  35. Stanghellini V, Armstrong D, Mönnikes H, Bardhan KD: Systematic review: do we need a new gastro-oesophageal reflux disease questionnaire? Aliment Pharmacol Ther 2004, 19:463–479.

    Article  PubMed  CAS  Google Scholar 

  36. Thomson ABR, Peter S: ReQuest is a powerful instrument to differentiate treatment response [abstract]. Can J Diagn 2007; 21(suppl A):118A.

    Google Scholar 

  37. Gillessen A, Schöffel L, Naumburger A: Financial restrictions in heath care systems could affect treatment of GERD patients. Clinical trial revealed significantly higher symptom load with omeprazole 20 mg compared to pantoprazole 40 mg. Z Gastroenterol 2006, 44:1–6.

    Article  Google Scholar 

  38. Glatzel D, Abdel-Qader M, Gatz G, Pfaffenberger B: Pantoprazole 40 mg is as effective as esomeprazole 40 mg to relieve symptoms of gastroesophageal reflux disease after 4 weeks of treatment and superior regarding the prevention of symptomatic relapse. Digestion 2006, 74:145–154.

    Article  PubMed  CAS  Google Scholar 

  39. Howden CW, Ballard ED, Robieson W: Evidence for therapeutic equivalence of lansoprazole 30 mg and esomeprazole 40mg in the treatment of erosive oesophagitis. Clin Drug Invest 2002, 22:99–109.

    Article  CAS  Google Scholar 

  40. Castell D, Kahrilas PJ, Richter JE, et al.: Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis. Am J Gastroenterol 2002, 97:575–583.

    Article  PubMed  CAS  Google Scholar 

  41. Fennerty MB, Johanson JF, Hwang C, Sostek M: Efficacy of esomeprazole 40 mg vs. lansoprazole 30 mg for healing moderate to severe erosive oesophagitis. Aliment Pharmacol Ther 2002, 21:455–463.

    Article  CAS  Google Scholar 

  42. Petite JP, Saludcci J, Grimaud JC, et al.: Lansoprazole versus omeprazole in the treatment of reflux oesophagitis. Med Chir Dig 1995, 24:291–294.

    Google Scholar 

  43. Castell DO, Richter JE, Robinson M, et al.: Efficacy and safety of lansoprazole in the treatment of erosive esophagitis. Am J Gastroenterol 1996, 91:1749–1757.

    PubMed  CAS  Google Scholar 

  44. Mee AS, Rowley JL: Rapid symptom relief in reflux oesophagitis: a comparison of lansoprazole and omeprazole. Aliment Pharmacol Ther 1996, 10:757–763.

    Article  PubMed  CAS  Google Scholar 

  45. Mulder CJ, Dekker W, Gerretsen M: Lansoprazole 30 mg versus omeprazole 40 mg in the treatment of reflux oesophagitis grade II, III and IVa (a Dutch multicentre trial). Dutch Study Group. Eur J Gastroenterol Hepatol 1996, 8:1101–1106.

    Article  PubMed  CAS  Google Scholar 

  46. Corallo J, Vicari F, Ferstler S, et al.: Lansoprazole in acute treatment of reflux esophagitis [abstract]. Gastroenterology 1993, 104:A58.

    Google Scholar 

  47. Hatlebakk JG, Berstad A, Carling L, et al.: Lansoprazole versus omeprazole in short-term treatment of reflux oesophagitis. Results of a Scandinavian multicentre trial. Scand J Gastroenterol 1993, 28:224–228.

    Article  PubMed  CAS  Google Scholar 

  48. Carling L, Axelsson CK, Forssell H, et al.: Lansoprazole and omeprazole in the prevention of relapse of reflux oesophagitis: a long-term comparative study. Aliment Pharmacol Ther 1998, 12:985–990.

    Article  PubMed  CAS  Google Scholar 

  49. Jasperson D, Diehl KL, Schoeppner H, et al.: A comparison of omeprazole, lansoprazole and pantoprazole in maintenance treatment of severe reflux oesophagitis. Aliment Pharmacol Ther 1998, 12:49–52.

    Article  Google Scholar 

  50. Mössner J, Holscher AH, Herz R, et al.: A double-blind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis: a multicentre trial. Aliment Pharmacol Ther 1995, 9:321–326

    Article  PubMed  Google Scholar 

  51. Corinaldesi R, Valetini M, Belaice J, et al.: Pantoprazole and omeprazole in the treatment of reflux oesophagitis: a European multicentre study. Aliment Pharmacol Ther 1995, 9:667–671.

    Article  PubMed  CAS  Google Scholar 

  52. Hotz J, Gangl A, Heinzerling H: Pantoprazole vs omeprazole in acute reflux esophagitis [abstract]. Gastroenterology 1996, 110:A136.

    Google Scholar 

  53. Thjodleifsson B, Dekkers CPM, Beker JA, et al.: Rabeprazole 20 mg/day is similar to omeprazole 20 mg/day in the treatment of erosive or ulcerative esophagitis [abstract]. Gastroenterology 1997, 112:A312.

    Google Scholar 

  54. Dekkers CPM, Beker JA, Thjodleifsson B, et al.: Double-blind, placebo-controlled comparison of rabeprazole 20 mg vs. omeprazole 20 mg in the treatment of erosive or ulcerative gastro-oesophageal reflux disease. Aliment Pharmacol Ther 1999, 13:49–57.

    Article  PubMed  CAS  Google Scholar 

  55. Labenz J, Armstrong D, Lauritsen K, et al.: A randomized comparative study of esomeprazole 40 mg versus pantoprazole 40 mg for healing erosive oesophagitis: the EXPO study. Aliment Pharmacol Ther 2005, 21:739–746.

    Article  PubMed  CAS  Google Scholar 

  56. Gralnek IM, Dulai GS, Fennerty MB, Spiegel BMR: Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol 2006, 4:1452–1458.

    Article  PubMed  CAS  Google Scholar 

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  1. Division of Gastroenterology, Department of Medicine, Zeidler Family Gastrointestinal Health & Research Institute, 130 University Campus, Edmonton, Alberta, T6G 2X8, Canada

    Alan B. R. Thomson

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Thomson, A.B.R. Standard doses of the oral proton pump inhibitors are clinically equivalent: A comparison. Curr GERD Rep 1, 223–232 (2007). https://doi.org/10.1007/s12171-007-0022-0

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