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Researchers find famotidine ineffective treatment in prevention of peptic ulcers

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WASHINGTON – Famotidine is not preventative as a treatment for the recurrence of peptic ulcers nor does it influence the action of ADP-receptor antagonists on platelet aggregation among patients with atherosclerosis or a history of peptic ulcers, according to findings presented at DDW 2015.

Ping-I Hsu, MD, PhD, a gastroenterologist from Kaohsiung Veterans General Hospital in Taiwan and a member of the Taiwan acid-related disease study group, conducted a randomized, controlled, double-blind, double-dummy trial at his institution to determine if histamine-2 receptor antagonists can prevent peptic ulcer recurrence in patients with atherosclerosis who have long-term usage of the platelet ADP-receptor antagonist thienopyridine.

Hsu also studied the effect of histamine-2 receptor antagonists on the antiplatelet action of thienopyridine.

“Some patients (11%) with a history of peptic ulcer who took clopidogrel for the prevention of ischemic events had ulcer recurrence within 6 months,” Hsu said during his presentation. “Additionally, 9% of patients with a history of a bleeding peptic ulcer and were taking clopidogrel had bleeding recurrence within 1 year. Can famotidine prevent recurrent peptic ulcer? That is what we wanted to investigate.”

Famotidine is used as an alternative to proton-pump inhibitors to prevent peptic ulcers for patients who take NSAIDs.

Hsu looked at a cohort of patients who were long-term thienopyridine users with a history of peptic ulcers, but had none at the time of their initial endoscopy. These patients were randomly assigned to receive either 20 mg famotidine twice daily or placebo for 6 months.

At the end of the 6-month period, patients received a follow-up endoscopy (they may have had one sooner if severe symptoms occurred). Platelet aggregates were tested on days 1 and 28 among 40 patients who participated in the pharmacodynamics study.

Peptic ulcers recurred in 8.2% of the patients (n = 98) in the famotidine arm and 12.9% of the patients (n = 101) in the placebo arm (difference, 4.7%; 95% CI, –3.8%-13.2%). Bleeding ulcer incidence was also comparable between the two arms with 2% in the famotidine group and 0% in the placebo group (95% CI, –0.8%-4.8%).

Finally, in the famotidine group, there was no difference in aggregate platelet percentages on days 1 and 28 (37.2% ± 19.6% vs. 44.7% ± 26.7%).

 “Famotidine does not influence the ADP-receptor antagonists and it cannot prevent recurrent peptic ulcers in ADP-receptor antagonist users with peptic ulcer history,” Hsu said. – by Anthony SanFilippo

For more information: Hsu, PI. Abstract 411. Presented at: Digestive Disease Week; May 15-19, 2015; Washington D.C.

Disclosure: Hsu reported no relevant financial disclosures.