Key result
Esomeprazole alone resulted in similar rates of peptic ulcer healing compared to esomeprazole plus aspirin (82.5% vs 81.5%; difference 1.0%, 95% CI -11.2 to 12.6%).
Why the study?
Does continuing aspirin with esomeprazole impair the healing of aspirin-related peptic ulcers compared to esomeprazole alone in patients with aspirin-related peptic ulcers?
RCT (n=178)
Does continuing aspirin with esomeprazole impair the healing of aspirin-related peptic ulcers compared to esomeprazole alone in patients with aspirin-related peptic ulcers?
Effect estimate: Difference 1.0% (95% CI -11.2 to 12.6)
Absolute Event Rate: 82.5% vs 81.5%
Continuing aspirin therapy alongside esomeprazole results in comparable ulcer healing rates to esomeprazole alone, though wide confidence intervals prevent ruling out a clinically meaningful difference.
Supports continuing aspirin with esomeprazole for aspirin-related ulcers; wide CIs leave open a clinically meaningful difference.
BACKGROUND: Aspirin-related peptic ulcers are a common disorder. However, whether or not aspirin should be continued during treatment for aspirin-related ulcers remains unclear. AIMS: To compare esomeprazole alone with esomeprazole plus aspirin in the treatment of aspirin-related peptic ulcers and to investigate the independent factors associated with the failure of ulcer healing. METHODS: From January 2008 to July 2011, patients with aspirin-related peptic ulcers were randomized to receive esomeprazole (40 mg per day) alone or esomeprazole (40 mg per day) plus aspirin (100 mg per day) for 8 weeks. The subjects with Helicobacter pylori infection were treated with standard triple therapy. Follow-up endoscopy was carried out at the end of the 8th week. The primary end point was the healing of peptic ulcers. RESULTS: In all, 178 patients (89 receiving esomeprazole alone and 89 receiving esomeprazole plus aspirin) were enrolled and underwent follow-up endoscopy. The healing rate of ulcers by modified intention-to-treat analysis was 82.5% (95% confidence interval (CI), 74.2-90.8%) among patients treated with esomeprazole alone and 81.5% (95% CI, 73.0-90.0%) among patients treated with esomeprazole plus aspirin (difference, 1.0%; 95% CI, -11.2 to 12.6%). The per-protocol analysis yielded similar results (healing rate: 83.1% vs. 83.8%, respectively; difference, 0.7%; 95% CI, -11.2 to 12.6%). Multivariate analysis disclosed that use of steroids during treatment (odds ratio: 5.6; 95% CI, 1.1-27.7%) was the only independent factor associated with the failure of ulcer healing. CONCLUSIONS: The observed ulcer healing rates were comparable in the esomeprazole and esomeprazole-plus-aspirin groups, but the wide CIs do not rule out clinically meaningful differences of more than 10%.
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Liu et al. (2012) conducted an RCT in Aspirin-related peptic ulcers (n=178). Esomeprazole alone vs. Esomeprazole (40 mg per day) plus aspirin (100 mg per day) was evaluated on healing of peptic ulcers (Difference 1.0%, 95% CI -11.2 to 12.6). Esomeprazole alone resulted in similar rates of peptic ulcer healing compared to esomeprazole plus aspirin (82.5% vs 81.5%; difference 1.0%, 95% CI -11.2 to 12.6%).