Last Updated: 2001-07-06 13:42:49 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – Treatment with a proton pump inhibitor provides better relief of heartburn than does treatment with an H2 receptor antagonist, investigators report. In addition, the researchers found that "step-up" and "step-down" strategies that use the proton pump inhibitor for only part of the treatment period are significantly less effective than a full course of the drug.
Dr. Colin W. Howden of Northwestern University in Chicago and associates compared outcomes for ranitidine (Zantac, GlaxoWellcome, Research Triangle Park, North Carolina) 150 mg b.i.d. and lansoprazole (Prevacid, TAP Pharmaceuticals, Deerfield, Illinois) 30 mg daily. The 251 subjects were randomized to receive ranitidine or lansoprazole for 20 weeks.
In addition, a "step-down" group of 134 subjects took lansoprazole for 8 weeks, then switched to ranitidine for 12 weeks. A 128-member "step-up" group took ranitidine for 8 weeks, following by lansoprazole for 12 weeks.
Whenever patients were taking lansoprazole, they experienced significantly less severe heartburn and a significantly higher proportion of heartburn-free days, the investigators report in the June issue of The American Journal of Gastroenterology. Fixed-dose ranitidine also resulted in less symptom severity than did step-down treatment.
Dr. Howden's team notes that outpatient use and office visits contribute the most to the costs of gastroesophageal reflux disease. "The most clinically effective pharmacological strategy may also be the most cost-effective by reducing additional resource use for further diagnostic evaluation or treatment changes," they write.
Editorialist Dr. James E. McGuigan, of the University of Florida College of Medicine in Gainesville, notes that third-party providers and health maintenance organizations sometimes require step-up or step-down regimens.
He adds that the results of the study by Dr. Howden's group "force us, as advocates for our patients, to question and re-examine the wisdom of insistence on step-up or step-down schedules in treatment of heartburn symptoms."
Am J Gastroenterol 2001;96:1679-1681,1704-1710.
-Westport Newsroom 203 319 2700
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