A systematic review including 5 RCTs with a total of 848 subjects was abstracted in DARE. There was a mean difference of 10% (p<0.01) in the rates of endoscopic healing at 4 weeks (85% vs 75%) in favour of lansoprazole compared to ranitidine or famotidine. At two weeks, the difference was 20% (60% vs 40%), and there was also a significant 8% difference in the proportion of patients with no pain.
Comment: The study was sponsored by the pharmaceutical company selling lansoprazole.
Another systematic review including 22 studies comparing omeprazole with ranitidine or cimetidine for duodenal ulcer, 4 studies comparing omeprazole with ranitidine or cimetidine for gastric ulcer, and 5 studies comparing omeprazole with ranitidine for reflux oesophagitis, was abstracted in DARE. Duodenal ulcer patients were included if they had minimum initial ulcer size of 5 mm and were treated initially for 2 weeks, with endoscopy and assessment of symptoms on day 15, and if unhealed, followed by 2 weeks further treatment and endoscopic assessment on day 29. Gastric ulcer (> 5 mm) patients and patients with erosive oesophagitis were treated for 4 weeks, endoscopy was performed on day 29, and if unhealed, 4 more weeks treatment with endoscopy on day 57.
Differences between omeprazole and ranitidine in proportion of symptom-free patients at 2 weeks were 14.1% (95% CI 10.5% to 17.7%) for duodenal ulcer, 8.9% (95% CI 0.7% to 17.1%) for gastric ulcer, 31.6% (95% CI 24.6% to 38.6%) for reflux oesophagitis. Similar differences were reported for studies comparing omeprazole with cimetidine. The drugs did not differ significantly for adverse effects.