Lansoprazole as good as famotidine for preventing recurrent bleeding after ulcer
Recurrent bleeding rates among patients with a history of Helicobacter pylori-negative idiopathic ulcer bleeding are low and do not significantly differ between users of the proton pump inhibitor (PPI) lansoprazole and the histamine 2 receptor antagonist (H2RA) famotidine, according to the results of an industry-independent trial.
The trial randomized 228 patients with a history of idiopathic bleeding ulcers to receive oral lansoprazole 30 mg (n=114; mean age, 67.6 years; 68.4 percent male) or famotidine 40 mg (n=114; mean age, 69.6 years; 55.3 percent male) daily for 24 months.
The primary endpoint of recurrent upper gastrointestinal (GI) bleeding within 24 months occurred in one patient in the lansoprazole arm (duodenal ulcer) and in three patients in the famotidine arm (two gastric ulcers and one duodenal ulcer), with corresponding cumulative incidence rates of 0.88 percent and 2.63 percent (crude hazard ratio, 0.33, 95 percent CI, 0.03–3.16; p=0.336).
None of the patients who experienced bleeding recurrence used aspirin, nonsteroidal anti-inflammatory drugs or other antithrombotic drugs.
The number of patients who discontinued treatment were similar: 27 (23.7 percent) in the lansoprazole arm and 26 (22.8 percent) in the famotidine arm. No cases of upper GI bleeding recurrence were recorded in the group of patients who discontinued medication early.
These findings provide novel data that may be used for future practice guidelines in the management of patients with a history of H. pylori-negative idiopathic bleeding ulcers, the researchers said.