Clinical Question: Is there any dif...

Clinical Question: Is there any difference between proton cross-question inhibitors (PPIs) for the treatment of gastroesophageal ebb disease (GERD)?

Setting: Various (meta-analysis)

investigation Design: Meta-analysis (randomized controlled trials)

Synopsis: This meta-analysis identified all double-blind randomized controll trials comparing single PPI with another for the treatment of GERD using endoscopic healing as the allusion standard for treatment success. A total of 19 studies, greatest in quantity lasting four weeks, with more than 9000 patients were identified. No difference was construct for the following comparisons: pantoprazole (Protonix) 40 mg versus omeprazole (Prilosec) 20 mg; pantoprazole 20 mg versus omeprazole 20 mg; lansoprazole (Prevacid) 30 mg versus omeprazole 20 mg; lansoprazole 15 mg versus omeprazole 20 mg; lansoprazole 30 mg versus omeprazole 40 mg; lansoprazole 30 mg versus pantoprazole 40 mg; rabeprazole (Aciphex) 20 mg versus omeprazole 20 mg; rabeprazole 10 mg versus omeprazole 20 mg; and omeprazole 20 mg versus esomeprazole (Nexium) 20 mg sole one comparison found a statistically significant difference between clumps in the treatment of GERD: esomeprazole 40 mg versus omeprazole 20 mg (80 versus 67 percent answer rate; P = .04; number straited to treat = 7). However, as noted above, a comparison in 1306 patients of equivalent doses of 20 mg esomeprazole versus 20 mg omeprazole lay the foundation of no difference in endoscopic healing. The answer rates for omeprazole 20 mg in the pair studies comparing it with esomeprazole 40 mg were 65 and 67 percent--considerably lower than in other comparisons looking at this dose, in which the succes rate was between 70 and 91 percent This would make esomeprazole contemplate more effective in comparison. Although this comparison has not at any time been made directly, it appears highly likely that 40 mg omeprazole ($40 by month over the counter) would be similar in effectiveness to 40 mg of esomeprazole ($142 by month).

Bottom Line: There is no significant difference between equivalent doses of PPIs, including equivalent doses of esomeprazole and omeprazole. The decision to cull one over another should be based first upon cost and second on individual patient answer (Level of Evidence: 1a)

MARK EBELL, MD MS

research Reference: Klok RM, et al. Meta-analysis: comparing the efficacy of proton cross-question inhibitors in short-term use. Aliment Pharmacol Ther May 15 2003;17:1237-45 Used with permission from Ebell M All PPIs equivalent for treatment of GERD Accessed online October 20 2005 at: http://www.InfoPOEMs.com.

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