Are There Differences Among PPIs in Clinical Practice? Should I Ever Consider Switching Among Different PPIs for Patients Who Fail to Respond?
Abstract
Careful examination of the many published pharmacodynamic studies reveals an often undiscussed but large interindividual and intraindividual variability in intragastric pH control with the various proton pump inhibitors (PPIs), either given once or even twice daily. This variability with twice-daily dosing is highlighted by a randomized crossover study in which healthy volunteers were given omeprazole 20 mg twice daily and lansoprazole 30 mg twice daily for 7 days separated by at least a 1-week washout period ( Figure 33-1 ). Intragastric pH monitoring was performed on day 7. Subjects were asked to eat similar meals on each study day. The study results revealed a wide variability in 24-hour pH control with both drugs. In addition, there is intrasubject variability, with some patients responding well to omeprazole and not lansoprazole as well as the reverse seen in several subjects. Although this inter- and intrasubject variability may not be of clinical importance when evaluating large groups of patients, the variability in response to PPIs may have clinical implications when patients fail to respond to the first PPI prescribed.
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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