Toss-up between PPIs, H2-receptor antagonists for aspirin GI protection

Last Updated: 2016-10-19

By Will Boggs MD

NEW YORK (Reuters Health) - Proton pump inhibitors (PPIs) and H2-receptor antagonists appear to offer similar protection against upper gastrointestinal (GI) bleeding and ulcers in high-risk users of low-dose aspirin, according to a randomized trial.

PPIs and H2-receptor antagonists are widely used and effective as gastroprotective agents, but it remains unclear how well they protect against aspirin-induced upper GI bleeding and ulcers in high-risk users.

One randomized trial found famotidine to be inferior to pantoprazole for preventing upper GI bleeding or severe dyspepsia, Dr. Francis K. L. Chan from Prince of Wales Hospital, Hong Kong, and colleagues note in Gastroenterology, online September 5.

The team investigated whether the PPI rabeprazole (20 mg once daily) is superior to the H2-receptor antagonist famotidine (40 mg once daily) for upper GI protection in aspirin users (80 mg once daily) with high risk of bleeding.

The rates of discontinuation were similar among the 138 patients randomly assigned to rabeprazole and the 132 randomly assigned to famotidine.

The cumulative incidence of upper GI bleeding during the 12-month study was 0.7% in the rabeprazole group and 3.1% in the famotidine group, a difference that fell short of statistical significance (p=0.16).

The rates of the composite endpoint of recurrent upper GI bleeding or recurrent endoscopic ulcers at the month 12 were also similar for patients receiving rabeprazole (7.9%) and famotidine (12.4%, p=0.26).

Four patients experienced lower GI bleeding - two in each treatment group - and seven patients experienced cardiothrombotic events - two receiving rabeprazole and five receiving famotidine.

"Therefore, our findings indicate that both treatments are comparable in preventing recurrent upper GI bleeding in high-risk aspirin users, although a small difference in efficacy cannot be excluded," the researchers conclude.

Dr. Deepak L. Bhatt, a professor of medicine at Harvard Medical School, Boston, who was not involved in the study, said it might be powered to detect a statistically significant difference.

"I would still prefer PPIs to H2-receptor antagonists, especially since so many generic options are now available," Dr. Bhatt told Reuters Health by email.

"The most important message is to think about using GI protection in patients at high risk for upper GI bleeding while on antiplatelet or anticoagulant therapy," he said.

The study had no commercial funding. The authors reported financial ties to numerous drugmakers.

Dr. Chan did not respond to a request for comments.

SOURCE: http://bit.ly/2cTMj27

Gastroenterol 2016.