The efficacy of lafutidine in improving preoperative gastric fluid property: a comparison with ranitidine and rabeprazole

Meta-analysis: comparative efficacy of H2-receptor antagonists and proton pump inhibitors for reducing aspiration risk during anaesthesia depending on the administration route and schedule

H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI) are widely used for aspiration prophylaxis in patients receiving general anaesthesia. Many randomized trials have compared these agents but it remains unclear which drug type is more effective in reducing the number of patients at risk of complications. The study aimed to compare their efficacy for decreasing the number of patients at risk of acid aspiration during general anaesthesia. Major databases were systematically searched. Randomized controlled trials comparing PPI and H2RA were selected. Sub-analyses were performed considering the dose, the dosing schedule, and the route of administration. Eighteen studies fulfilled the inclusion criteria. The main analysis showed a non-significant trend for H2RA being more effective than PPI. Only when both drugs were administered per os, as a single dose and immediately before surgery, was H2RA significantly more effective than PPI. By contrast, the effect of PPI and H2RA was similar when they were administered in two doses (the night before and on the morning of surgery) or when the drugs were given intravenously. A single H2RA dose before surgery is highly effective in reducing the number of patients at risk of acid aspiration. PPI administered in two oral doses or in a single intravenous infusion seems to be as effective as H2RA.

Lafutidine 10 mg versus Rabeprazole 20 mg in the Treatment of Patients with Heartburn-Dominant Uninvestigated Dyspepsia: A Randomized, Multicentric Trial

Background. Empirical therapy with antisecretory agents like PPIs and H2RAs has long been the traditional approach in the initial management of uninvestigated dyspepsia. Aim. The objective of the study was to examine relief of dyspepsia with lafutidine, a second-generation H(2)-RA, and rabeprazole and to compare their efficacy. Methods. This was a randomized, open, comparative trial in adult uninvestigated dyspeptic patients, who had at least moderate severity of symptoms, defined as a score of ≥4 on a 7-point global overall symptom (GOS) scale, and were randomized to receive once daily either lafutidine 10 mg or rabeprazole 20 mg for 4 weeks. Results. A total of 236 patients were enrolled, out of which 194 patients were included in the analysis. At the end of week 4, a significant difference was observed for symptom relief (lafutidine 89.90% versus rabeprazole 65.26%, P < .01) and symptom resolution (lafutidine 70.71% versus rabeprazole 25.26%, P < .01). Both the drugs were well tolerated. Conclusion. Both lafutidine and rabeprazole provide symptom relief in patients with heartburn-dominant uninvestigated dyspepsia. The present study confirms the appropriateness of lafutidine as an empiric treatment and superior efficacy for primary care practice patients with dyspepsia.

An open-label, randomized, cross-over bioequivalence study of lafutidine 10 mg under fasting condition

AIM: To assess the relative bioavailability and pharmacokinetic properties of two formulations (test and reference) of Lafutidine 10 mg.

METHODS: The study was performed as an open label, randomized, two-way, two-period, two-treatment, single dose cross-over bioequivalence study, under non-fed condition to compare the pharmacokinetic profiles of the lafutidine formulation manufactured by Emcure Pharmaceuticals Ltd., India using an indigenously developed active pharmaceutical ingredient (API) and the commercially available Stogra^® formulation, of UCB Japan Co., Ltd., Japan. The two treatments were separated by a wash-out period of 5 d. After an overnight fasting period of 10 h, the subjects were administered either the test or the reference medication as per the randomization schedule. Blood samples were collected at intervals up to 24 h, as per the approved protocol. Concentrations of lafutidine in plasma were analyzed by a validated liquid chromatography/tandem mass spectrometry (LC/MS/MS) method, and a non-compartmental model was used for pharmacokinetic analysis. The pharmacokinetic parameters were subjected to a 4-way ANOVA accounting for sequence, subjects, period and treatment. Statistical significance was evaluated at 95% confidence level (P ≥ 0.05).

RESULTS: The mean (± SD) values of the pharmacokinetic parameters (test vs reference) were C_max (265.15 ± 49.84 ng/mL vs 246.79 ± 29.30 ng/mL, P < 0.05), Area under the curve (AUC)_(0-t) (1033.13 ± 298.74 ng.h/mL vs 952.93 ± 244.07 ng.h/mL, P < 0.05), AUC_(0-∞) (1047.61 ± 301.22 ng.h/mL vs 964.21 ± 246.45 ng.h/mL, P < 0.05), and t_½(1.92 ± 0.94 h vs 2.05 ± 1.01 h, P < 0.05). The 90% confidence intervals (CI) for the test/reference ratio of mean C_max, AUC_(0-t), and AUC_(0-∞) were within the acceptable range of 80.00 to 125.00. The mean times (± SD) to attain maximal plasma concentration (t_max) of lafutidine were 0.95 ± 0.24 h vs 1.01 ± 0.29 h (P < 0.05) for the test and the reference formulations respectively. Both the formulations were well tolerated.

CONCLUSION: In summary, this study has demonstrated the bioequivalence of the two formulations of lafutidine 10 mg. Hence it can be concluded that the two formulations can be used interchangeably in clinical settings.

Effect of preoperative intravenous pantoprazole in elective-surgery patients: a pilot study

BACKGROUND

This study evaluated the effects of intravenous pantoprazole on gastric volume and acid output in elective-surgical patients.

METHODS

This is a multicenter, randomized, pilot study of adult patients receiving intravenous pantoprazole: 40 mg every 24 h, 40 mg every 12 h (q12h) or 80 mg q12h. The first dose was administered 1 h before general anesthesia for surgery. All gastric fluid was aspirated through a nasogastric tube 1 h before dosing and through the postoperative period. Aspirate volume was recorded; pH and H(+) concentrations were measured.

RESULT

Twenty-six patients were enrolled and 21 were evaluable. Pantoprazole was well tolerated. All regimens decreased gastric acid output and volume, and increased pH within 1 h of dosing. Effects were sustained for up to 12 h following single-dose administration.

CONCLUSIONS

Intravenous pantoprazole administered prior to anesthesia induction may be efficacious for the reduction of gastric volume and acid output, and for pulmonary aspiration prophylaxis in surgical patients.

Reducing gastric secretions--a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?

GOALS OF WORK

Inoperable bowel obstructions are not uncommon in advanced cancer and are associated with a very poor prognosis. Symptom control includes reducing the frequency of vomiting by prescription of antisecretory medications. The most commonly used agents for this are either hyoscine butylbromide or octreotide. Either histamine 2 antagonists or proton pump inhibitors are sometimes recommended as adjuvants to reduce gastric secretions. The aim of this study was to examine the effects of histamine 2 antagonists and proton pump inhibitors and to objectively compare the effects of one agent over another.

MATERIALS AND METHODS

Previously, electronic databases were searched for trials that compared ranitidine versus proton pump inhibitors in their effect on volume of gastric aspirates.

RESULTS

Seven trials were included in a meta-analysis. Pooled outcomes suggest that both proton pump inhibitors and ranitidine reduce gastric volumes, but the most superior agent is ranitidine, which reduces the volume of gastric secretions by an average of 0.22 ml.kg(-1); 95% confidence interval 0.04 to 0.41.

CONCLUSIONS

Based on well-conducted studies, objective evidence exists that confirms ranitidine will decrease the volume of gastric aspirates. This forms a sound basis from which to develop further research aimed at improving the care of people with malignant bowel obstructions.