ASK DIS: PPI: Comparison

Friday, August 5, 2016

Generally according to FDA-approved indications of PPIs, it is used for the prevention and treatment of gastric acid related conditions.

PPIs differ in their routes of excretion, peak plasma levels, and half lives as shown in the table below. ¹

Comparison: General

Generally all PPIs have equal potency and effectiveness but some PPIs have advantages over one another in certain diseases.
Esomeprazole is more superior than omeprazole in healing erosive esophagitis.
If in short term effect, esomperazole is more effective in healing esophagitis compared to pantoprazole.
Generally for the long term effect, esomeprazole, pantoprazole, lansoprazole are equally effective in treating mild to moderate esophagitis.

Comparison: Pantoprazole

Pantoprazole and omeprazole are safe and effective but pantoprazole is more effective than omeprazole in healing acute and benign gastric ulcer.
Pantoprazole has less interaction with clopidogrel compared to omeprazole.
Pantoprazole also is more safe in pregnancy since it is in category B while omeprazole is in category C.
The table below shows the indication and regimen of drugs in PPIs group

Evidences: General

There is a good evidence showed no difference between omeprazole, lansoprazole, pantoprazole, and rabeprazole for healing of erosive esophagitis. There are thirteen head-to-head trials found these 4 proton pump inhibitors to be equally effective in healing at 4 and 8 weeks.²
Pooled analysis of 4 and 8-week healing rates of erosive esophagitis from 4 trials of esomeprazole 40 mg compared to omeprazole 20 mg indicated esomeprazole to be more superior than omeprazole. ²
Esomeprazole 40 mg was more effective at healing esophagitis at 4 and 8 weeks than omeprazole 20 mg and lansoprazole 30 mg. Besides that, at 4 weeks, esomeprazole 40 mg had a higher healing rate than pantoprazole 40 mg but there is no difference was found in a single small study of patients with mild to moderate esophagitis at weeks.²
There are three head-to-head trials in patients with gastroesophageal reflux disease but without erosive esophagitis on endoscopy found no difference between esomeprazole 20 mg and omeprazole 20 mg, pantoprazole 20 mg, or rabeprazole 10 mg. ²

Evidences: Pantoprazole

Pantoprazole, 40 mg once daily in the morning, is a highly effective, well tolerated treatment for acute, benign gastric ulcer compared to Omeprazole 20mg but pantoprazole and omeprazole were equally safe in the therapy of gastric ulcer.⁶
Pantoprazole 40 mg and omeprazole MUPS 40 mg were equivalent with respect to healing after 4 and 8 weeks of treatment in patients with reflux esophagitis grade II/III. Both drugs were well tolerated and safe.⁷
There is one study shows that patients receiving pantoprazole had a significantly better platelet response to clopidogrel as assessed with the PRI VASP compared to patients receiving omeprazole. The present findings suggest the preferential use of pantoprazole compared with omeprazole in patients receiving clopidogrel to avoid any potential negative interaction with CYP2C19. ⁸

Reference

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