Esomeprazole 20 mg on‐demand is more acceptable to patients than continuous lansoprazole 15 mg in the long‐term maintenance of endoscopy‐negative gastro‐oesophageal reflux patients: the COMMAND Study

• Published in: Alimentary pharmacology & therapeutics Vol. 20; no. 6; pp. 657 - 665
• Main Authors: Tsai, H. H., Chapman, R., Shepherd, A., McKeith, D., Anderson, M., Vearer, D., Duggan, S., Rosen, J. P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 15-09-2004; Blackwell
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - adverse effects; Biological and medical sciences; Digestive system; Esomeprazole - administration & dosage; Esomeprazole - adverse effects; Esomeprazole - analogs & derivatives; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - drug therapy; Humans; Lansoprazole; Medical sciences; Middle Aged; Patient Satisfaction; Pharmacology. Drug treatments; Single-Blind Method; Treatment Outcome; Human; Gastroesophageal reflux; Enzyme; Esophageal disease; H; Enzyme inhibitor; Antiulcer agent; K; Long term; Proton pump inhibitor; Benzimidazole derivatives; Antisecretory agent; Esomeprazole; Digestive diseases; exchanging ATPase; Hydrolases; Endoscopy; Lansoprazole
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2004.02155.x

Summary
Background : Symptom relief, through adherence to appropriate maintenance therapy, is the sole objective of treatment for patients with endoscopy‐negative gastro‐oesophageal reflux disease.
Aim : To compare the efficacy of ‘on‐demand’ treatment with esomeprazole 20 mg vs. continuous treatment with lansoprazole 15 mg daily in patients with endoscopy‐negative gastro‐oesophageal reflux disease.
Methods : Endoscopy‐negative gastro‐oesophageal reflux disease patients who achieved complete resolution of heartburn after short‐term (2–4 weeks) treatment with esomeprazole 20 mg (n = 774) were randomized to receive either esomeprazole 20 mg on‐demand (n =311) or lansoprazole 15 mg continuous daily treatment (n = 311) for 6 months.
Results : Significantly more patients were willing to continue taking esomeprazole on‐demand than lansoprazole continuous therapy after 6 months (93% vs. 88%; P = 0.02). This superior outcome was achieved despite patients on esomeprazole requiring medication only 38% as often as those on lansoprazole, leading to direct cost savings of more than one‐third (36%). Furthermore, patients receiving esomeprazole 20 mg on‐demand were more satisfied with their treatment after 1 month compared with patients taking lansoprazole 15 mg continuously.
Conclusions : In patients with endoscopy‐negative gastro‐oesophageal reflux disease, esomeprazole 20 mg on‐demand is more acceptable to patients and is an economically more effective treatment than lansoprazole 15 mg continuously.