Q: Over many years, the difference in cost between omeprazole and some of the other proton-pump inhibitors (PPIs) can add up to thousands of dollars. There seems to be a widespread belief (based mostly on anecdotal experience) that other PPIs work better. Are there any data that might convince me either to stick with the more affordable omeprazole or go with the allegedly more efficacious alternatives?
A: One would certainly be hard-pressed to make a case that any of the other PPIs are “more efficacious” than the less expensive omeprazole. For most common indications, e.g., gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and
Helicobacter pylori eradication, omeprazole is as effective as the alternatives. Comparative studies of pantoprazole and omeprazole in the treatment of gastric ulcers, for example, showed similar rates of healing. One multicenter, randomized, double-blind study of 219 patients done over an eight-week period showed healing rates of 97.3% for pantoprazole 40 mg daily vs. 95.9% for omeprazole 20 mg daily (
Aliment Pharmacol Ther. 1995;9:19-24). Similarly designed trials comparing omeprazole with lansoprazole or rabeprazole for PUD had consistent findings demonstrating equal efficacy (
Clin Ther. 1993;15 Suppl B:2-13 and
J Gastroenterol Hepatol. 2006; 21:1381-1387). The data for eradication of GERD symptoms and esophageal damage are so compellingly unremarkable in similarity as to not justify the use of more expensive alternatives unless patient preference and subjective experience of adverse effects come in to play (
Eur J Gastroenterol Hepatol. 2002;14:649-656).