Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial

TLDR

Esomeprazole’s pharmacologic profile offers advantages over omeprazole, suggesting clinical benefits for patients with acid‑related disease. In a double‑blind, multicentre RCT of 1960 reflux oesophagitis patients, participants were randomized to esomeprazole 40 mg, esomeprazole 20 mg, or omeprazole 20 mg for up to 8 weeks, with the primary outcome the proportion healed at week 8 and secondary outcomes including heartburn resolution and safety. Esomeprazole 40 mg and 20 mg produced higher healing rates at week 8 (94.1 % and 89.9 % vs 86.9 %) and superior heartburn resolution at week 4, with similar tolerability to omeprazole, confirming its greater efficacy in reflux oesophagitis.

Abstract

Background: The pharmacologic profile of the new proton pump inhibitor esomeprazole has demonstrated advantages over omeprazole that suggest clinical benefits for patients with acid‐related disease. Methods: 1960 patients with endoscopy‐confirmed reflux oesophagitis (RO) were randomized to once daily esomeprazole 40 mg ( n =654) or 20 mg ( n =656), or omeprazole 20 mg ( n =650), the standard recommended dose for RO, for up to 8 weeks in a US, multicentre, double‐blind trial. The primary efficacy variable was the proportion of patients healed at week 8. Secondary variables included healing and heartburn resolution at week 4, time to first resolution and sustained resolution of heartburn, and per cent of heartburn‐free days and nights. Safety and tolerability were also evaluated. Results: Significantly more patients were healed at week 8 with esomeprazole 40 mg (94.1%) and 20 mg (89.9%) vs. omeprazole 20 mg (86.9%), using cumulative life table estimates, ITT analysis (each P < 0.05). Esomeprazole 40 mg was also significantly more effective than omeprazole for healing at week 4 and for all secondary variables evaluating heartburn resolution. The most common adverse events in all treatment groups were headache, abdominal pain and diarrhoea. Conclusion: Esomeprazole was more effective than omeprazole in healing and symptom resolution in GERD patients with reflux oesophagitis, and had a tolerability profile comparable to that of omeprazole.