Acid control with esomeprazole and lansoprazole: A comparative dose–response study

Objective. To determine the level of acid control and the dose–response relationships achieved with esomeprazole and lansoprazole. These data are relevant in helping clinicians to decide on whether to increase a proton-pump inhibitor dose, or whether to switch to an alterative drug for increased acid control. Material andmethods. In an open-label, single-centre, randomized, six-way crossover study, 40 healthy subjects received esomeprazole 20, 40 and 80 mg, and lansoprazole 15, 30 and 60 mg once daily for 5 days. The mean time with intragastric pH >4 and mean 24-h median intragastric pH on day 5 were analyzed using a mixed-model ANOVA. Post-hoc analyses were completed for 0–12-h (daytime) and 12–24-h (night-time) post-dose intervals. Results. Increasing the dose of esomeprazole from 20 mg to 40 mg resulted in significantly improved acid control over 0–12, 12–24 and 0–24 h post-dose (p<0.001), but no significant improvement in acid control for either period was seen when further increasing the dose to 80 mg. Increasing the dose of lansoprazole from 15 mg to 30 mg or from 30 mg to 60 mg significantly improved acid control over 0–12 and 0–24 h (p<0.01) but not over 12–24 h. With the exception of the esomeprazole 20 mg versus lansoprazole 30 mg comparisons, and the esomeprazole 20 mg versus lansoprazole 15 mg during 12–24 h post-dose comparison, esomeprazole provided significantly greater acid control than lansoprazole at each dose level over 0–12, 12–24 and 0–24 h (p<0.05). Mean 24-h median intragastric pH was higher following esomeprazole dosing compared with lansoprazole at each dose level. Conclusions. For low-, standard- and double-dose comparisons, esomeprazole achieved greater elevation of gastric pH and better acid control in more subjects than lansoprazole. Use of esomeprazole may therefore reduce the need for dose adaptations or drug switching.     

Interleukin‐8 expression in the esophageal mucosa of patients with gastroesophageal reflux disease

Background: It has been reported that inflammatory cell infiltration can be detected in patients with endoscopically negative gastroesophageal reflux disease (GERD) as well as those with erosive reflux esophagitis. In this study, we examined the expression of mRNA for interleukin (IL)‐8, a potent chemokine for neutrophils, in the esophageal mucosa of patients with GERD and compared the results with their endoscopic findings and symptoms. Methods: Biopsy samples were obtained from 80 patients. Endoscopic diagnosis was performed according to the Los Angeles classification. Patients with typical symptoms such as heartburn despite normal endoscopic findings were classified as the non‐erosive GERD group. Total cellular RNA was extracted from the biopsy samples and IL‐8 mRNA was quantified by real‐time polymerase chain reaction (PCR). Localization of IL‐8 protein in the esophageal mucosa was done by immunostaining. Results: Expression of IL‐8 mRNA was correlated with the endoscopic grade of esophagitis or with inflammatory cell infiltration, but not with the symptoms of the patients. Expression of IL‐8 mRNA was also detected in all patients with non‐erosive GERD. The level of IL‐8 expression in non‐erosive GERD was low compared with that in erosive GERD, but was higher than that in normal controls. IL‐8 immunostaining was found in the basal layers of the esophageal mucosa. Administration of lansoprazole, a proton‐pump inhibitor, decreased both IL‐8 mRNA and protein levels in the esophageal mucosa. Conclusion: These results suggest that IL‐8 in the esophageal mucosa may be involved in the pathogenesis of esophageal inflammation, including non‐erosive GERD.     

Mosapride as an adjunct to lansoprazole for symptom relief of reflux oesophagitis

AIMS

To investigate if mosapride, a prokinetic agent, was an effective adjunct to acid suppression in improving the symptoms of reflux oesophagitis.

METHODS

Patients (n= 96) with reflux oesophagitis were randomly assigned to either mosapride (5 mg three times daily) or placebo for 4 weeks. Symptom severity was assessed by a validated questionnaire at enrolment, 4 and 8 weeks after medication. The primary outcome for the first 4 weeks was decrease in symptom scores. After a 3 day washout period, patients initially allocated to mosapride crossed over to placebo and vice versa for the next 4 weeks. The outcome of the second phase was maintenance of symptom control. All patients received lansoprazole (30 mg once daily) throughout study.

RESULTS

The decreased symptom score after 4 weeks of treatment with lansoprazole and mosapride (n= 50) was 13.42 ± 1.16 (mean ± SEM), similar to that of lansoprazole plus placebo (10.85 ± 1.03, n= 46), with an insignificant difference of 2.57 (95% CI −0.53, 5.67, P= 0.103). However, a sub-group analysis for patients with pre-treatment scores of >18 points (n= 48) revealed that lansoprazole plus mosapride achieved a greater reduction of symptom score than lansoprazole plus placebo (18.22 ± 1.91 vs. 12.88 ± 1.65; mean difference of 5.34, 95% CI 0.28, 10.40, P= 0.039). In the second phase, there was no difference between lansoprazole with mosapride or placebo in maintaining symptom control (39/44 or 86.64% vs. 41/50 or 82%, P= 0.401). Subgroup analysis for those with substantial residual symptoms revealed similar results.

CONCLUSION

Compared with placebo, mosapride generally does not provide additional benefit to a standard dose of lansoprazole in patients with reflux oesophagitis, except possibly in the subgroup of severely symptomatic patients.     

手性Chiralcel OD-RH柱拆分3种质子泵抑制剂对映体

目的建立了以纤维素-三(3,5-二甲基苯基氨基甲酸酯)为手性固定相拆分兰索拉唑、雷贝拉唑和泮托拉唑对映体的高效液相色谱法(HPLC)。方法考察了流动相中有机改性剂的种类和比例、pH、流速和柱温等对对映体分离的影响。结果拆分兰索拉唑、雷贝拉唑的流动相为水-甲醇(15:85);拆分泮托拉唑的流动相为磷酸盐缓冲液(pH6.0,20mmol.L-1)-乙腈(70:30)。结论兰索拉唑、雷贝拉唑和泮托拉唑对映体均可以在Chiralcel OD-RH手性柱上实现完全分离。     

单剂量静脉滴注兰索拉唑在中国健康人体的药代动力学

目的 研究中国健康志愿者单次静脉滴注兰索拉唑(抑胃酸药)的药代动力学特点.方法 12名健康志愿者,先后单次静滴3个剂量(15,30,60 mg)兰索拉唑;用高效液相色谱-紫外检测法测定给药后不同时间点的血药浓度,用3P97软件计算药代动力学参数.结果 血药浓度-时间曲线符合二房室模型,健康受试者单次静滴3个剂量(15,30,60 mg)兰索拉唑后主要的药代动力学参数:C_(max)分别为(1105.65±506.24),(2171.33±799.02),(4070.53±643.04)μg·L~(-1);t_(1/2)分别为(1.63±0.86),(2.30±2.01),(1.90±1.19)h;AUC_(0-12)分别为(991.16±814.49),(3495.87±1770.92),(8351.14±2599.90)μg·h·L~(-1).结论 兰索拉唑的体内过程在男女性别间无显著差异,剂量在15～60 mg内较安全.     

兰索拉唑肠溶片处方工艺及质量研究

考察了各种辅料与兰索拉唑之间的影响因素,筛选出合适辅料,并采用单因素法优化兰索拉唑肠溶片的处方工艺.结果表明,所研制的兰索拉唑肠溶片经高温、高湿和强光影响因素和加速试验考察,0.1 mol/L盐酸2 h药物释放量小于10%;在pH 6.8磷酸盐缓冲液中45 min药物释放度大于80%;有关物质含量小于2%.     

浅析固体口服制剂的工艺验证

本文主要对工艺验证的含义、进行工艺验证的前提条件、工艺验证方案和工艺验证报告的具体内容进行了阐述,并以某片剂为例进行了进一步详述。工艺验证是确证生产工艺是否可连续生产出符合质量标准要求的产品的研究过程,进行工艺验证前,应通过详细的工艺研究对工艺有充分的理解。工艺验证方案是用于指导如何具体实施工艺验证的文件,工艺验证报告是如实记录工艺验证结果并对验证结果进行评价的文件。     

Cytochrome P450 2C19 polymorphism influences the preventive effect of lansoprazole on the recurrence of erosive reflux esophagitis

BACKGROUND: The efficacy of lansoprazole (LPZ) at inhibiting gastric acid secretion is influenced by cytochrome P450 2C19 (CYP2C19) polymorphism. The purpose of the present study was to investigate whether CYP2C19 polymorphism had an influence on the remission of erosive reflux esophagitis (RE) during maintenance therapy with LPZ. METHODS: Eighty-two Japanese patients with initial healing of erosive RE by 8 weeks of LPZ therapy were enrolled. As maintenance therapy, the patients were treated with LPZ (15 mg/day) for 6 months. The CYP2C19 genotype, Helicobacter pylori infection status, and serum pepsinogen (PG) I/II ratio were assessed before treatment. The patients were investigated for relapse by endoscopy at 6 months or when symptoms recurred. RESULTS: The proportion of patients in remission after 6 months was 61.5%, 78.0%, and 100% among homozygous extensive metabolizers (homo-EM), heterozygous EM (hetero-EM), and poor metabolizers (PM), respectively. The percentage of PM patients who remained in remission was significantly higher than that of homo-EM or hetero-EM. CONCLUSIONS: The efficacy of LPZ (15 mg/day) as maintenance therapy for erosive RE is influenced by CYP2C19 polymorphism.     

兰索拉唑对离体壁细胞酸分泌的影响

目的应用兔离体壁细胞为模型,研究兰索拉唑体外抑酸效果.方法应用细胞淘洗与连续密度梯度离心相结合的方法分离兔胃黏膜壁细胞,以14C氨基比林摄取为酸分泌指标,观察西咪替丁及兰索拉唑对离体壁细胞组胺诱导的酸分泌的影响.结果壁细胞纯度达80%以上进行实验,兰索拉唑能明显抑制离体壁细胞组胺诱导的酸分泌,对组胺刺激酸分泌的50%抑制量(IC50)为9.59×10-8mol/L,明显高于H2受体拮抗剂(3.70×10-5mol/L).结论兰索拉唑对兔离体壁细胞组胺诱导的酸分泌具明显的抑制作用,效果优于西咪替丁;本研究为国内开展新的抑酸剂基础与临床研究提供了新方法.     

Diarrhea associated with lansoprazole

Lansoprazole is a proton pump inhibitor widely prescribed for gastroesophageal reflux and benign peptic ulcer disease. According to the manufacturer's package insert (TAP Pharmaceuticals, Lake Forest, IL, USA), the most common side-effects are diarrhea, headache and abdominal pain, which occur in approximately 3% of patients and are reversible with drug discontinuation. An unusual case of microscopic colitis is reported in a previously asymptomatic patient who developed new-onset diarrhea after initiation of lansoprazole. The case is reviewed and possible mechanisms of diarrhea secondary to proton pump inhibitors are discussed.