Effectiveness of Changing Drug Classes in Patients With Refractory Laryngopharyngeal Reflux Disease

• Published in: Otolaryngology-head and neck surgery 2025-02, Vol.172 (2), p.483-490
• Main Authors: Herman, Emilie, Saussez, Sven, Lechien, Jérôme R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; change; Drug Substitution; Female; gastroesophageal; head neck surgery; Humans; laryngology; laryngopharyngeal; Laryngopharyngeal Reflux - drug therapy; Male; medication; Middle Aged; otolaryngology; Prospective Studies; Proton Pump Inhibitors - therapeutic use; reflux; refractory; Retrospective Studies; Treatment Outcome
• ISSN: 0194-5998; 1097-6817; 1097-6817
• DOI: 10.1002/ohn.996

Objective To investigate the effectiveness of drug class changes in patients with refractory laryngopharyngeal reflux disease (LPRD). Study Design Retrospective case series with prospective data. Setting Multicenter study. Methods The data of patients treated for a refractory LPRD from September 2017 to December 2023 were collected. The effectiveness of drug class changes was assessed through the reflux symptom score (RSS) change. Signs were evaluated with the Reflux Sign Assessment. The RSS reduction was used to categorize the therapeutic responses as mild (20%‐40% RSS reduction), moderate (40.1%‐60% RSS reduction), high (60.1%‐80%), and complete (>80%). Results Among the 334 medical records, 74 (22.2%) patients had refractory LPRD defined as no RSS change in the pre‐ to 3‐month posttreatment. The mean age was 52.6 ± 15.5 years. Changing drug class was associated with significant 3‐ to 6‐month posttreatment reductions of RSS and RSA. Thirty patients (39%) did not experience symptom reduction after changing drugs. Changing alginate to magaldrate and magaldrate to alginate was associated with the highest responder rate (76.9%). Changing PPI and alginate/magaldrate molecules led to a response rate of 62.5%. In patients initially treated with a combination of PPI and alginate or magaldrate, changing PPI without changing alginate/magaldrate led to a 37.5% response rate. The baseline RSS was predictive of the 3‐ and 6‐month RSS (therapeutic response). Conclusion Changing drug class, especially alginate‐to‐magaldrate, may be an effective therapeutic approach for patients with a refractory LPRD.