Saturday, July 18, 2009
PPI
Opposing View, Proton-Pump Inhibitors Better Option
However, David A. Johnson, MD, FACG, FACP, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk and past president of the American College of Gastroenterology, disagrees. "The problems I have [with the study] are the applications to real life," Dr. Johnson told Medscape Gastroenterology. "This patient group was just taking low-dose aspirin. And in real life, a lot of people take more than that. So applications beyond just low-dose aspirin or patients taking some other NSAIDs on a sporadic or even on a concomitant basis would not be appropriate from the data they did in this trial, where they were very restricted."
He said that both the American College of Gastroenterology's guidelines and the consensus statement that the American College of Gastroenterology wrote with the American College of Cardiology in fall 2008 say that proton-pump inhibitors are still the preferred strategy. "In comparative trials, not just low-dose aspirin but for patients taking regular NSAIDs, [PPIs] are just more effective."
Dr. Johnson said that an H2 receptor antagonist may have some benefit if looking only at cost factors. However, "This study was dated at a time when H2 receptor antagonists were being compared to prescription costs of PPIs. Now, with the availability of generics and over the counter PPIs, I think the cost strategy needs to be re-evaluated. From the standpoint of compliance and efficacy, I still see that the proton pump inhibitor recommendation stands as the most viable for patients deemed at risk."
This study was funded by Merck Laboratories and Astellas Pharma. The study drugs (famotidine and placebo) were donated by Merck Laboratories, United Kingdom. Dr. Taha has received research grants and travel expenses from Astellas, AstraZeneca, Merck, and Yamanouchi. The other study authors have disclosed no financial relationships.
Dr. Hawkey has received research funding and/or honoraria from Bayer, Logical Therapeutics, Albireo AB, Novartis Pharma, Pfizer, and NicOx.
Dr. Johnson has received grants for clinical research and served as an advisor or consultant for AstraZeneca Pharmaceuticals LP and TAP Pharmaceutical Products Inc. He has also served as an advisor or consultant for Dynogen Pharmaceuticals, Inc.
Lancet. Published online July 6, 2009.
