バレット食道におけるエソメプラゾールとアスピリン (AspECT):ランダム化因子試験

Janusz A Z Jankowski¹, John de Caestecker², Sharon B Love³

¹Gastroenterology Unit, Morecambe Bay University Hospitals NHS Trust, Lancaster, UK; National Institute for Health and Care Excellence, London, UK.

Lancet (London, England)

|July 31, 2018

まとめ

高用量プロトンポンプ阻害剤 (PPI) とアスピリンは,Barrettの食道患者に著しく改善した. 高用量のPPIとアスピリンの併用は,最も強力な保護効果を示し,報告された有害事象は最小でした.

科学分野:

胃腸内科
腫瘍学
臨床薬理学

背景:

食道腺がんは世界的にがんによる死亡の主な原因です
バレットの食道はこの癌の主な危険因子です
化学予防戦略の評価はバレットの食道管理に不可欠です

研究の目的:

高用量プロトンポンプ阻害剤 (PPI) とアスピリンの効果を評価する.
高用量対低用量PPIを,アスピリンと併用して,化学予防試験で比較する.

主な方法:

85のセンターで2557人の患者が参加した2x2因子ランダム化試験です.
患者は少なくとも8年間,高用量 (40 mg/日2回) または低用量 (20 mg/日1回) のPPIを,アスピリンと併用して投与された (300~325 mg/日).
主要エンドポイント:全因死亡率,食道腺がん,または高度不発症までの時間,加速障害時間モデリングを使用して分析.

主要な成果:

高用量PPIは低用量PPIよりも優れていた (p=0. 038).
非ステロイド抗炎症薬の使用が検閲されたとき,アスピリンは有意な効果を示した (p=0. 043).
高用量のPPIとアスピリンの併用は,最も強力な保護効果を示した (p=0. 0068) で,報告された有害事象は少ない.

結論:

高用量のPPIとアスピリンの化学予防は,特に併用すると,バレット食道患者での結果が著しく改善されます.
この治療法は安全であることが判明し,研究参加者の1%だけが治療に関連した深刻な有害事象を報告した.
これらの発見は,高用量のPPIとアスピリンのバレット食道の管理と食道腺がんの予防のための使用を支持します.

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