Holding the mirror up to esomeprazole

National Prescribing Service Limited ACN 082 034 393

An independent, Australian organisation for Quality Use of Medicines

ISSN 1441-7421 April 2004

Holding the mirror up to esomeprazole

In 2003, esomeprazole had the largest growthb of any drug on the PBS.1 Interestingly, the same molecule has long been available as half of the active ingredient of omeprazole.

Esomeprazole and omeprazole have the same pharmacological activity Esomeprazole is the s-enantiomer of omeprazole (see Single enantiomer drugs, page 4). In contrast to some other isomer drugs, esomeprazole and r-omeprazole have the same pharmacological activity.15

The major difference between the enantiomers is in their pharmacokinetics: after equivalent doses, esomeprazole reaches higher plasma concentrations.16 The standard daily dose of esomeprazole is 40 mg, which is four times the amount of esomeprazole found in a standard daily dose of omeprazole (Table 1). Clinical efficacy comparisons with other PPIs Studies so far have compared esomeprazole 40 mg or 20 mg with standard or lower doses of other PPIs. However, esomeprazole 40 mg is considerably more expensive than standard doses of other PPIs (Table 2).17 There have been no clinical efficacy studies comparing esomeprazole 40 mg and omeprazole 40 mg.

Healing rates in erosive oesophagitis

In published studies in erosive oesophagitis, esomeprazole 40 mg produced small improvements in healing rates and symptom resolution over standard doses of omeprazole or lansoprazole (Figure 1).18–20 An unpublished study found no difference in healing rates between esomeprazole 40 mg and omeprazole 20 mg.21 Relapse prevention in erosive oesophagitis Esomeprazole 20 mg offers little advantage over less expensive low-dose lansoprazole in preventing relapse in healed erosive oesophagitis; 11 people would need to be treated for 6 months with esomeprazole 20 mg instead of lansoprazole 15 mg to prevent one additional relapse.7 Symptom control in endoscopy-negative GORD More than 50% of people with GORD have no evidence of erosive oesophagitis.2 In this group, esomeprazole at a dose of either 40 mg or 20 mg is no more effective at controlling symptoms than omeprazole 20 mg.21 b Highest volume change over 12 months ending December 2003.

http://www.nps.org.au/__data/assets/pdf_file/0016/15820/news33_PPIs_0404.pdf