Omeprazole (Page 10 of 12)

14.3 Active Benign Gastric Ulcer

In a U.S. multicenter, double-blind, study of omeprazole 40 mg once daily, 20 mg once daily, and placebo in 520 patients with endoscopically diagnosed gastric ulcer, the following results were obtained.

Treatment of Gastric Ulcer % of Patients Healed (All Patients Treated)

Omeprazole 20 mg once daily (n = 202) Omeprazole 40 mg once daily (n = 214) Placebo (n = 104)
Week 4 47.5 1 55.6 1 30.8
Week 8 74.8 1 82.71,2 48.1

1 . (p < 0.01) omeprazole 40 mg or 20 mg versus placebo.

2 . (p < 0.05) omeprazole 40 mg versus 20 mg.

For the stratified groups of patients with ulcer size less than or equal to 1 cm, no difference in healing rates between 40 mg and 20 mg was detected at either 4 or 8 weeks. For patients with ulcer size greater than 1 cm, 40 mg was significantly more effective than 20 mg at 8 weeks.

In a foreign, multinational, double-blind study of 602 patients with endoscopically diagnosed gastric ulcer, omeprazole 40 mg once daily, 20 mg once daily, and ranitidine 150 mg twice a day were evaluated.

Treatment of Gastric Ulcer % of Patients Healed (All Patients Treated)

Omeprazole 20 mg once daily (n = 200) Omeprazole 40 mg once daily (n = 187) Ranitidine 150 mg twice daily (n = 199)
Week 4 63.5 78.1 1,2 56.3
Week 8 81.5 91.4 1,2 78.4

1 . (p < 0.01) omeprazole 40 mg versus ranitidine.

2 . (p < 0.01) omeprazole 40 mg versus 20 mg.

14.4 Symptomatic GERD

A placebo-controlled study was conducted in Scandinavia to compare the efficacy of omeprazole 20 mg or 10 mg once daily for up to 4 weeks in the treatment of heartburn and other symptoms in GERD patients without EE. Results are shown below.

%Successful Symptomatic Outcome 1

Omeprazole 20 mg a.m. Omeprazole 10 mg a.m. Placebo a.m.
All patients 46 2,3 (n = 205) 31 3 (n = 199) 13 (n = 105)
Patients with confirmed GERD 56 2,3 (n = 115) 36 3 (n = 109) 14 (n = 59)

1. Defined as complete resolution of heartburn.

2. (p < 0.005) versus 10 mg.

3. (p < 0.005) versus placebo.

14.5 EE due to Acid-Mediated GERD

In a U.S. multicenter double-blind placebo controlled study of 20 mg or 40 mg of omeprazole delayed-release capsules in patients with symptoms of GERD and endoscopically diagnosed EE of grade 2 or above, the percentage healing rates (per protocol) were as follows:

20 mg Omeprazole (n = 83) 40 mg Omeprazole (n = 87) Placebo (n = 43)
Week 4 39 1 45 1 7
Week 8 74 1 75 1 14

1. (p < 0.01) omeprazole versus placebo.

In this study, the 40 mg dose was not superior to the 20 mg dose of omeprazole in the percentage healing rate. Other controlled clinical trials have also shown that omeprazole is effective in severe GERD. In comparisons with histamine H 2 -receptor antagonists in patients with EE, grade 2 or above, omeprazole in a dose of 20 mg was significantly more effective than the active controls. Complete daytime and nighttime heartburn relief occurred significantly faster (p < 0.01) in patients treated with omeprazole than in those taking placebo or histamine H 2 — receptor antagonists.

In this and five other controlled GERD studies, significantly more patients taking 20 mg omeprazole (84%) reported complete relief of GERD symptoms than patients receiving placebo (12%).

14.6 Maintenance of Healing of EE due to Acid-Mediated GERD

In a U.S. double-blind, randomized, multicenter, placebo controlled study, two dose regimens of omeprazole were studied in patients with endoscopically confirmed healed esophagitis. Results to determine maintenance of healing of EE are shown below.

Life Table Analysis

Omeprazole 20 mg once daily (n = 138) Omeprazole 20 mg 3 days per week (n = 137) Placebo (n = 131)
Percent in endoscopic remission at 6 months 70 1 34 11

1. (p < 0.01) OMEPRAZOLE 20 mg once daily versus omeprazole 20 mg 3 consecutive days per week or placebo.

In an international multicenter double-blind study, omeprazole 20 mg daily and 10 mg daily were compared with ranitidine 150 mg twice daily in patients with endoscopically confirmed healed esophagitis. The table below provides the results of this study for maintenance of healing of EE.

Life Table Analysis

Omeprazole 20 mg once daily (n = 131) Omeprazole 10 mg once daily (n = 133) Ranitidine 150 mg twice daily (n = 128)
Percent in endoscopic remission at 12 months 77 1 58 2 46

1. (p = 0.01) omeprazole 20 mg once daily versus omeprazole 10 mg once daily or Ranitidine.

2 . (p = 0.03) omeprazole 10 mg once daily versus Ranitidine.

In patients who initially had grades 3 or 4 erosive esophagitis, for maintenance after healing 20 mg daily of omeprazole was effective, while 10 mg did not demonstrate effectiveness.

14.7 Pathological Hypersecretory Conditions

In open studies of 136 patients with pathological hypersecretory conditions, such as Zollinger-Ellison (ZE) syndrome with or without multiple endocrine adenomas, omeprazole delayed-release capsules significantly inhibited gastric acid secretion and controlled associated symptoms of diarrhea, anorexia, and pain. Doses ranging from 20 mg every other day to 360 mg per day maintained basal acid secretion below 10 mEq/hr in patients without prior gastric surgery, and below 5 mEq/hr in patients with prior gastric surgery.

Initial doses were titrated to the individual patient need, and adjustments were necessary with time in some patients [see Dosage and Administration (2)]. Omeprazole was well tolerated at these high dose levels for prolonged periods (> 5 years in some patients). In most ZE patients, serum gastrin levels were not modified by omeprazole. However, in some patients serum gastrin increased to levels greater than those present prior to initiation of omeprazole therapy. At least 11 patients with ZE syndrome on long-term treatment with omeprazole developed gastric carcinoids. These findings are believed to be a manifestation of the underlying condition, which is known to be associated with such tumors, rather than the result of the administration of omeprazole [see Adverse Reactions (6)].

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