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Standard PPI doses effective among patients with heartburn, elevated BMI
Patients with heartburn and high BMI experienced similar or better response to therapy with proton pump inhibitors than patients with lower BMI in a recent study.
Researchers evaluated data from multiple phase 3 studies on the effect of proton pump inhibitor (PPI) therapy in 621 patients with nonerosive GERD (NERD) and 2,692 with erosive esophagitis (EO). Those with NERD were assigned either 30 mg dexlansoprazole MR or placebo daily for 4 weeks, and patients with EO were assigned either 30 mg lansoprazole or 60 mg dexlansoprazole MR daily for 8 weeks.
Among evaluable patients stratified according to BMI, heartburn severity at baseline increased with BMI in both cohorts, with significance achieved in the EO group (P<.001) but not the NERD group (P=.483 for dexlansoprazole recipients; P=.225 for placebo recipients). A 30-mg dose of dexlansoprazole improved symptom severity for patients with NERD, regardless of BMI (P≤.0001). Patients with EO who received dexlansoprazole experienced better treatment response with a higher BMI compared with those in the lowest BMI category (P=.013).
Patients with EO and higher BMI had more heartburn-free days during treatment compared with patients with lower BMI (P=.002 for dexlansoprazole; P=.04 for lansoprazole). Dexlansoprazole also improved the number of heartburn-free days among patients with NERD, regardless of BMI (P≤.0001 compared with placebo).
Healing rates among patients with EO were similar between 60 mg dexlansoprazole and lansoprazole recipients after 4 weeks of treatment (P=.14), but higher with dexlansoprazole after 8 weeks (P=.003).
David A. Peura
“PPIs are able to reduce frequency and severity of GERD symptoms regardless of baseline BMI,” researcher David A. Peura, MD, professor emeritus of internal medicine in the gastroenterology and hepatology division at the University of Virginia Health Sciences Center, told Healio.com. “In fact, since those patients with a higher BMI had more severe symptoms before treatment, they may actually experience a greater symptom benefit from their PPI than leaner patients. … Clinicians will be interested to know that PPIs work well at the usual doses regardless of BMI.”
Disclosure: See the study for a full list of relevant disclosures.