Long-term ranitidine inferior to lansoprazole
Reducing the secretion of stomach acid is still the best way to achieve remission for stubborn cases of esophagitis, but a new study suggests one drug may be far superior to another in achieving that goal. A multicenter study of 159 patients with persistent esophagitis found that lansoprazole beat ranitidine hands-down when it came to healing esophageal lesions. Patients also felt better when taking lansoprazole vs. ranitidine.
The news comes just as Novopharm gets ready to launch the first generic version of ranitidine, making the product more affordable for managed care organizations and patients alike. Until now, only the expensive brand name Zantac has been available.
The study split the patients into three groups. The first took ranitidine twice daily for eight weeks; the second, a daily dose of lansoprazole; and the third, lansoprazole dosed at 30 mg a day initially then rising to 60 mg a day depending on symptom improvement. In all, 105 patients took lansoprazole; 54, ranitidine.
Faster healing observed
Even by the end of the second week, the group taking lansoprazole recorded significantly better rates of complete healing (as seen through an endoscope) than the ranitidine group: about 28% for ranitidine, almost 63% for lansoprazole. Results improved by weeks four and eight, with the lansoprazole group recording an 84% cure rate by the end of eight weeks of therapy.
Interestingly, the ranitidine group stopped improving between weeks four and eight, with the number of ranitidine patients classified as "completely healed" dropping off significantly. The authors suggest the drop-off indicates recurrent esophagitis and the futility of using ranitidine long-term for the disease.
Dosing lansoprazole at 60 mg a day apparently is futile as well. The authors say 30 mg works just fine to heal esophageal lesions, but patients reported less heartburn using the higher dose. Both ranitidine and lansoprazole were generally well-tolerated, with only a few subjects dropping out of the study because of adverse effects.
One problem with lansoprazole is that it interferes with the new diagnostic test for H. pylori peptic ulcers. A study finds that 61% of the time lansoprazole will create a false negative on the C-urea breath test. Ranitidine affects the test in 18% of cases. Patients should complete a five-day washout period before taking the breath test.
Reference
Sontag, et al. Lansoprazole heals erosive reflux esophagitis resistant to histamine H-2 receptor antagonist therapy. Am J Gastroenterology 1997; 92(3).
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