PPI vs H2RA in Patients With Helicobacter Pylori-Negative Idiopathic Bleeding Ulcers - Full Text View

Purpose

The aim of this study is to compare the efficacy of a proton pump inhibitor (lansoprazole) and a histamine-2 receptor antagonist (famotidine) in preventing recurrent ulcer bleeding in patients with a history of H. pylori-negative idiopathic peptic ulcers.

Condition	Intervention	Phase
Peptic Ulcer	Drug: Lansoprazole Drug: Famotidine	Phase 4


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Prevention
Official Title:	Prevention of Recurrent Idiopathic Gastroduodenal Ulcer Bleeding: a Double-blind Randomized Trial

Resource links provided by NLM:

MedlinePlus related topics: Bleeding Peptic Ulcer

Drug Information available for: Famotidine Lansoprazole Famotidine hydrochloride Dexlansoprazole

U.S. FDA Resources

Further study details as provided by Francis KL Chan, Chinese University of Hong Kong:

Primary Outcome Measures:

Recurrent ulcer bleeding [ Time Frame: 24 months ]
According to prespecified criteria — hematemesis or melena documented by the admitting physician, or a decrease in the hemoglobin level of at least 2 g/dL, with ulcers or bleeding erosions confirmed on endoscopy.

A prespecified interim-analysis is performed on the primary endpoint when all patients have been randomised and have completed the 12 months follow-up. The interim-analysis is performed by an independent statistician, blinded for the treatment allocation. The statistician will report to the independent data and safety monitoring committee (DSMC). The DSMC will have unblinded access to all data and will discuss the results of the interim-analysis with the steering committee in a joint meeting. The steering committee decides on the continuation of the trial and will report to the central ethics committee. The Peto approach is used: the trial will be ended using symmetric stopping boundaries at P < 0.001.

Secondary Outcome Measures:

Recurrent ulcer detected by endoscopy at 24-month [ Time Frame: at the 24th month of follow-up ]
Recurrent ulcer detected by endoscopy at 24-month, with or without clinical symptoms.


Estimated Enrollment:	228
Actual Study Start Date:	June 2010
Estimated Study Completion Date:	May 2019
Estimated Primary Completion Date:	December 2018 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Lansoprazole 30mg once daily Lansoprazole 30mg once daily	Drug: Lansoprazole 30mg once daily
Active Comparator: Famotidine 40mg once daily Famotidine 40mg once daily	Drug: Famotidine 40mg once daily

Detailed Description:

Peptic ulcer disease used to be caused by a bacterial infection (Helicobacter pylori) in the stomach or the use of certain painkillers (nonsteroidal anti-inflammatory drugs or NSAIDs). However, there has been an increasing trend of peptic ulcer disease with unknown cause (idiopathic ulcer) worldwide since the last decade. Studies in North America found that idiopathic ulcers accounted for 11% and 44% of all peptic ulcers. A meta-analysis of 7 US trials found that 20% of patients with H. pylori-associated ulcers had recurrent ulcers within 6 months, despite successful cure of H. pylori infection and no reported use of NSAIDs. In a pooled analysis of 6 clinical trials with a total of 2900 patients, 27% of duodenal ulcers were not associated with NSAID use or H. pylori infection. The emerging problem of H. pylori-negative idiopathic peptic ulcers is not only limited to western countries. Previously, H. pylori-negative idiopathic peptic ulcers accounted for less than 5% of peptic ulcers in Asia. A recent Korean study reported that the proportion of peptic ulcers not associated with H. pylori infection or NSAID use was over 20%.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

A history of H. pylori-negative idiopathic peptic ulcers, defined as
1. No exposure to aspirin, NSAIDs or drugs of unknown nature including traditional Chinese medicine within the 4 weeks before hospitalization;
2. Biopsies taken during endoscopy must be negative for both the urease test and histology for H. pylori in the absence of acid suppressive therapy; and
3. No other causes of ulceration identified.
Endoscopically confirmed ulcer healing
Age >18 years old
Informed consent

Exclusion Criteria:

Concomitant steroid or anticoagulant
Concomitant use of NSAIDs, aspirin or COX2 inhibitors
Previous gastric surgery
Requirement of maintenance PPI (e.g. reflux oesophagitis)
Advanced comorbidity (defined as ASA 4 or above) or active malignancy
Subjects who are pregnant or lactating, or is intending to become pregnant before, during, or within 1 month after participating in this study
Subjects who have known hypersensitivity or allergies to any component of lansoprazole or famotidine.
Subject who has current or historical evidence of Zollinger-Ellison syndrome or other hypersecretory condition

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01180179

Locations


China, Hong Kong
Endoscopy Center, Prince of Wales Hospital, Shatin
Hongkong, Hong Kong, China

Sponsors and Collaborators

Chinese University of Hong Kong

Investigators


Principal Investigator:	Grace L Wong, MD	Chinese University of Hong Kong

More Information


Responsible Party:	Francis KL Chan, Professor, Chinese University of Hong Kong
ClinicalTrials.gov Identifier:	NCT01180179 History of Changes
Other Study ID Numbers:	NNH_RCT
Study First Received:	August 3, 2010
Last Updated:	August 15, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	No

Keywords provided by Francis KL Chan, Chinese University of Hong Kong:


H. pylori-negative idiopathic peptic ulcers Recurrent ulcer bleeding

Additional relevant MeSH terms:


Ulcer Hemorrhage Peptic Ulcer Pathologic Processes Duodenal Diseases Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Stomach Diseases Lansoprazole Dexlansoprazole	Famotidine Anti-Ulcer Agents Gastrointestinal Agents Proton Pump Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Histamine H2 Antagonists Histamine Antagonists Histamine Agents Neurotransmitter Agents Physiological Effects of Drugs

ClinicalTrials.gov processed this record on August 18, 2017