Proton pump inhibitor therapy: preliminary results of a therapeutic interchange program

To analyze the experience of one Department of Veterans Affairs hospital in treating with lansoprazole all patients with acid-peptic disease requiring proton pump inhibitor therapy, including newly diagnosed patients and those who were previously stabilized on omeprazole.

Retrospective analysis.

We evaluated the charts of 78 patients seen between March 17, 1997, and November 1998 by the Gastroenterology Section at the Togus Veterans Administration Hospital who were diagnosed with acid-peptic disease.

Overall, side effects necessitated discontinuation of therapy in 10 (13%) of the lansoprazole-treated patients and none of the omeprazole-treated patients. Nine patients on lansoprazole suffered from persistent diarrhea and were placed on omeprazole, and one had lower back pain and was switched to cimetidine therapy. Additionally, 12 patients (15%) had their lansoprazole therapy discontinued because of lack of efficacy. Of the 78 lansoprazole-treated patients, 22 (28%) failed to respond to treatment.

Although this study represents preliminary findings and the statistics are observational in nature, important lessons can be learned. At this particular institution, the potential 12% savings from a mandated therapeutic interchange program were quickly offset by the overall lansoprazole-associated failure rate of 28%. The reproducibility of these preliminary results from an omeprazole-to-lansoprazole therapeutic interchange program in other institutions is unknown but warrants further consideration and additional studies, including those evaluating cost efficacy.