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Author: Admin | 2025-04-28
Omeprazole, the studies were not fair comparisons. Both studies used higher dosages of esomperazole compared with omeprazole. This cannot be considered a true comparison of effectiveness. Mark: This is a classic example of a “straw man comparison.” A straw man comparison is when a study intentionally compares drugs of differing doses in order to set up one as a clear “winner” in effectiveness. In the study comparing esomeprazole with omeprazole, esomeprazole did better. Well, that's no surprise—esomeprazole is the active isomer of omeprazole, and the study authors used a dosage four times that of omeprazole. Breaking this down, they used 40 mg of active drug esomeprazole versus 10 mg of active drug omeprazole (the dosage is actually 20 mg, but since omeprazole is a racemic mixture, that is only 10 mg of active drug), and guess what? The drug not going off patent did better! And who sponsored the study? Astra-Zeneca, the manufacturer. Bob: I knew you would jump on the inappropriate comparison of esomeprazole with omeprazole. Another problem with this comparison is that a true clinical end point is not being measured. Although an endoscopic result sounds like a good “gold standard” measurement, it is considered a “DOE” or “disease-oriented evidence” and not a clinical outcome. Abdominal pain or gastrointestinal bleeding are clinical end points that are important to patients and would be considered a “POEM” or “patient-oriented evidence that matters.” So, my conclusion regarding GERD is that there are no differences among PPIs. As for the nine studies on peptic ulcer disease, they found the same results as those found with GERD, except this time, pantoprazole 40 mg barely had better endoscopic healing than omeprazole 20 mg at four weeks (91 versus 86 percent; NNT = 20). But I have the same complaints as I did with the
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