Predictable prolonged suppression of gastric acidity with a novel proton pump inhibitor, AGN 201904-Z

BACKGROUND

AGN 201904-Z is a new, slowly absorbed, acid-stable pro-proton pump inhibitor (pro-PPI) rapidly converted to omeprazole in the systemic circulation giving a prolonged residence time.

AIM

To investigate pharmacodynamics and pharmacokinetics of AGN 201904-Z compared to esomeprazole.

METHODS

A randomized, open-label, parallel group, investigator-blinded intragastric pH study was conducted in 24 healthy Helicobacter pylori negative male volunteers. AGN 201904-Z enteric-coated capsules (600 mg/day) or esomeprazole delayed-release tablets (40 mg/day) were administered for 5 days. Twenty-four-hour intragastric pH recordings were acquired at baseline, days 1, 3 and 5 with blood levels of omeprazole, AGN 201904-Z and gastrin.

RESULTS

On day 1, median nocturnal pH and proportion of nocturnal time with pH >or=4 and 24-h and nocturnal time pH >or=5 were significantly higher with AGN 201904-Z than esomeprazole. At day 5, 24-h and median nocturnal pH were significantly higher for AGN 201904-Z than esomeprazole (P < 0.0001). There was also a marked reduction in periods of nocturnal pH <4.0. Area under curve of the AGN 201904-Z active metabolite (omeprazole) in the blood was twice that of esomeprazole at day 5.

CONCLUSIONS

AGN 201904-Z produced a significantly greater and more prolonged acid suppression than esomeprazole, and nocturnal acid suppression was more prolonged over all 5 days. AGN 201904-Z should provide true once-a-day treatment and better clinical efficacy than current PPIs.

Apocaligonellidus nom. nov. for Echinopsis Fan &amp; Chen, 1996, preoccupied (Acari: Prostigmata: Raphignathoidea: Xenocaligonellididae)

In 1996 we proposed the name Echinopsis for a monotypic new genus in the mite family Xenocaligonellididae (= Xenocaligonellidae) (Fan and Chen, 1996), without noticing that the same name had already been used for an echinodermatan genus (Agassiz 1840; Mortensen 1951). So a new name is required for that genus. Apocaligonellidus nom. nov. is hereby proposed as a replacement.

Enlarging the deficient mandible

The authors describe a technique to improve skeletal contours of the deficient mandible with normal occlusion using alloplastic implants, often in combination with chin lengthening or shortening. Successful outcomes depend on knowledge of normal facial skeletal relationships, appropriately designed biocompatible implants, and facility with craniofacial techniques.