Clinical trials: healing of erosive oesophagitis with dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed‐release formulation – results from two randomized controlled studies

• Published in: Alimentary pharmacology & therapeutics 2009-04, Vol.29 (7), p.731-741
• Main Authors: SHARMA, P., SHAHEEN, N. J., PEREZ, M. C., PILMER, B. L., LEE, M., ATKINSON, S. N., PEURA, D.
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles - adverse effects; 2-Pyridinylmethylsulfinylbenzimidazoles - therapeutic use; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Delayed-Action Preparations - therapeutic use; Dexlansoprazole; Digestive system; Dose-Response Relationship, Drug; Double-Blind Method; Esophagitis - drug therapy; Esophagitis - physiopathology; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lansoprazole; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Treatment Outcome; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2009.03933.x

Summary Background  Dexlansoprazole MR employs a dual delayed‐release delivery system that extends drug exposure and prolongs pH control compared with lansoprazole. Aim  To assess the efficacy and safety of dexlansoprazole MR in healing erosive oesophagitis (EO). Methods  Patients in two identical double‐blind, randomized controlled trials (n = 4092) received dexlansoprazole MR 60 or 90 mg or lansoprazole 30 mg once daily. Week 8 healing was assessed using a closed testing procedure – first for non‐inferiority, then superiority, vs. lansoprazole. Secondary endpoints included week 4 healing and week 8 healing in patients with moderate‐to‐severe disease (Los Angeles Classification grades C and D). Life‐table and crude rate analyses were performed. Symptoms and tolerability were assessed. Results  Dexlansoprazole MR achieved non‐inferiority to lansoprazole, allowing testing for superiority. Using life‐table analysis, dexlansoprazole MR healed 92–95% of patients in individual studies vs. 86–92% for lansoprazole; the differences were not statistically significant (P > 0.025). Using crude rate analysis, dexlansoprazole MR 90 mg was superior to lansoprazole in both studies and 60 mg was superior in one study. Week 4 healing was >64% with all treatments in both studies. In an integrated analysis of 8‐week healing in patients with moderate‐to‐severe EO, dexlansoprazole MR 90 mg was superior to lansoprazole. All treatments effectively relieved symptoms and were well tolerated. Conclusion  Dexlansoprazole MR is highly effective in healing EO and offers benefits over lansoprazole, particularly in moderate‐to‐severe disease.