Prevacid
Impact of a formulary change in proton pump inhibitors on health care costs and patients' symptoms.

Raisch DW, Klaurens LM, Hayden C, Malagon I, Pulliam G, Fass R.

VA Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico 87104, USA.

Patients may fail to successfully undergo a switch in therapy associated with a formulary change. The aim of this study was to measure health care costs and outcomes among patients who failed a formulary change in proton pump inhibitors in a VA medical center. Patients who failed a switch from omeprazole to lansoprazole (N = 51) were matched with patients who were successfully switched (N = 51). Health care utilization data was gathered from VA electronic databases and medical records for six months before and after the switch and, for failure patients, during the lansoprazole trial period. Statistical comparisons between failure and success patients were performed on changes in health care costs between these time periods. Health outcome data for the lansoprazole trial period and subsequent omeprazole reinstatement period were obtained through a telephone questionnaire of failure patients. Changes in total health care utilization costs did not differ significantly between failure and success groups for any of the time periods. Failure patients had significantly poorer health outcomes during their lansoprazole trial periods with significantly greater severity of heartburn and severity and frequency of acid regurgitation (P < 0.001). In conclusion, the formulary change had a negative impact upon health outcomes among failure patients but did not significantly affect their health care utilization costs. Identification of failure patients early in their lansoprazole trial periods could improved their health outcomes and satisfaction with medical care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11478507&dopt=Abstract lansoprazole Prevacid



Prevacid
Comparison of lansoprazole and famotidine for gastric acid inhibition during the daytime and night-time in different CYP2C19 genotype groups.

Shirai N, Furuta T, Xiao F, Kajimura M, Hanai H, Ohashi K, Ishizaki T.

First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. naohito hama-med.ac.jp

BACKGROUND: The acid inhibitory effect of lansoprazole depends on the S-mephenytoin 4'-hydroxylase (CYP2C19) genotype status. The effect of famotidine is independent of this genotype. AIM: To investigate the acid inhibitory effects of lansoprazole vs. famotidine during the daytime and night-time with reference to different CYP2C19 genotypes. METHODS: Fifteen healthy volunteers were given 20 mg famotidine twice a day or 30 mg lansoprazole once a day for 8 days. On post-dose day 8, 24-h intragastric pH monitoring was performed. RESULTS: During the daytime, the intragastric pH with lansoprazole was significantly higher than that with famotidine in the heterozygous extensive metabolizer group, whereas no significant difference was observed in the homozygous extensive metabolizer group. During the night-time, the intragastric pH with famotidine was quite similar to that with lansoprazole in the heterozygous extensive metabolizer and poor metabolizer groups. However, during the night-time, the intragastric pH with famotidine was significantly higher than that with lansoprazole in the homozygous extensive metabolizer group. CONCLUSIONS: An insufficient acid inhibition by lansoprazole during the night-time in the homozygous extensive metabolizer group could be compensated for by famotidine. CYP2C19 genotype testing appears to be useful for predicting the optimal acid inhibitory drug treatment collated with circadian intragastric pH change.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11929404&dopt=Abstract lansoprazole Prevacid



Prevacid
Effects of therapy with lansoprazole on intestinal permeability and inflammation in young cystic fibrosis patients.

Hendriks HJ, van Kreel B, Forget PP.

Department of Paediatrics, University Hospital of Maastricht, Maastricht, The Netherlands. jhe skin.azm.nl

BACKGROUND: Defective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeability in cystic fibrosis (CF). METHODS: In this open study, the authors evaluated the effect of a proton-pump inhibitor on intestinal permeability and inflammation in 14 young, pancreatic-insufficient CF patients. Permeability was measured by a three-sugar permeability test before and after 1 year of lansoprazole use, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation. RESULTS: After 1 year of lansoprazole use, median urinary recovery percentages changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no significance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, and L-rhamnose, respectively. Despite the fact that the median urinary excretion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.176 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, respectively, they both remained increased. Median urinary NO products-to-creatinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency toward a decrease in the NO products-to-creatinine ratio during treatment, this was not significant at the end point. CONCLUSIONS: Intestinal permeability is considerably increased in CF patients and is partly corrected after the use of a proton-pump inhibitor for 1 year, which may point to a harmful effect of the acid luminal contents on the tight junctional related paracellular permeability pathway. The start and end values for the NO products-to-creatinine ratio in CF patients were not significantly different, but were considerably increased when compared with control participants (P = 0.002).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11593119&dopt=Abstract lansoprazole Prevacid



Prevacid
Patient perceptions of a proton pump inhibitor therapeutic interchange program across the continuum of care.

Sodorff MM, Galt KA, Galt MA, Turner PD, Lambrecht JE.

Center for Practice Improvement and Outcomes Research, Creighton University, Omaha, Nebraska, USA. sodorfm shmc.org

OBJECTIVE: To determine if participation in a hospital-based proton pump inhibitor (PPI) therapeutic interchange program resulted in differences in patient perceptions related to clinical and humanistic outcomes. METHODS: A quasiexperimental repeated-measures study compared patients' perceptions in two groups (111 patients) at hospital admission, discharge, 3-4 days after discharge, and 2-3 weeks after discharge to detect differences across the continuum of care. Patient awareness of the hospital-based interchange also was examined. Clinical and quality-of-life outcomes were measured by using a condition-specific instrument modified for use with patients. Satisfaction and expectations were measured by using extent-of-agreement measures. Group 1 (60 patients) was prescribed omeprazole before admission, switched to lansoprazole during hospitalization, and discharged taking omeprazole. Group 2 (51 patients) was prescribed lansoprazole before admission and continued taking lansoprazole throughout hospitalization and after discharge. Patients who were unable to communicate or who had a substantial change in severity of illness (not attributable to gastrointestinal disorders) during the study were excluded. RESULTS: No significant differences were found between groups 1 and 2 for clinical outcomes, quality of life, extent to which expectations were met, or satisfaction at the four time periods. Nineteen (36%) of 53 surveyed patients in group 1 were not aware that their therapy had been interchanged while in the hospital. CONCLUSION: Patient-perceived outcomes and expectations of therapy across the continuum of care were not affected by a hospital-based PPI therapeutic interchange program.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11939685&dopt=Abstract lansoprazole Prevacid



Prevacid
A prospective follow-up study of 5669 users of lansoprazole in daily practice.

Leufkens H, Claessens A, Heerdink E, van Eijk J, Lamers CB.

Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), The Netherlands.

BACKGROUND: Immediately after the introduction of the proton pump inhibitor lansoprazole, a 2-year follow-up study was started to evaluate patterns of use, safety and effectiveness of this drug in naturally occurring groups of patients in the Netherlands. Medical data were recorded by participating physicians while medication listing were provided by pharmacists. METHODS: The study was designed according to the Safety Assessment of Marketed Medicines guidelines. The only inclusion criterion was the use of lansoprazole prior to entry into the study. RESULTS: A total of 5669 lansoprazole users was included by 374 general practitioners and 117 specialists. Lansoprazole was mostly prescribed in patients with reflux oesophagitis (55.1%), 'gastritis' (26.8%) and duodenal ulcers (11.4%), sometimes as part of a Helicobacter pylori eradication therapy (8.5%). For their complaints most patients (91.1%) had previously used acid-related drugs. Improvement or disappearance of complaints was achieved in 88.9% and 90.5% of patients after 4 and 8 weeks of treatment, respectively. Diarrhoea (4.1%), headache (2.9%) and nausea (2.6%) were the most frequently reported adverse events. CONCLUSION: The patterns of use of lansoprazole in daily practice deviated from the recommendations in the information leaflet. Nevertheless, lansoprazole was found to be safe in this naturally occurring group of users. Effectiveness appeared to be comparable to results found in clinical trials of the registered indications for lansoprazole.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9354197&dopt=Abstract lansoprazole Prevacid