Key result
Concomitant use of esomeprazole or famotidine did not significantly differ in their effect on the antiplatelet efficacy of dual antiplatelet therapy at 30 days.
Why the study?
It remains controversial whether PPI interactions with DAPT are drug-specific or a class effect, and whether the H2RA famotidine interacts with DAPT.
Does esomeprazole compared to famotidine affect residual platelet reactivity in patients on dual antiplatelet therapy after percutaneous coronary intervention?
RCT (n=160)
Single-blind
Randomized
No
Does esomeprazole compared to famotidine affect residual platelet reactivity in patients on dual antiplatelet therapy after percutaneous coronary intervention?
Absolute Event Rate: 35.6% vs 36.8%
p-value: p=0.235
Concomitant use of esomeprazole or famotidine does not differentially affect the antiplatelet efficacy of aspirin and clopidogrel in patients undergoing PCI, suggesting the interaction is drug-specific rather than a class effect.
Either agent acceptable for gastroprotection with DAPT post-PCI; confirms interaction is drug-specific rather than class effect.
BACKGROUND: Regarding drug interactions between proton pump inhibitors (PPIs) and dual antiplatelet therapy (DAPT), controversies have arisen over the possibility that PPIs may interfere with the antiplatelet effect of DAPT. However, whether this interaction is drug-specific or a class effect needs to be determined. It is not clear whether famotidine, an H2-receptor antagonist (H2RA), interacts with DAPT. OBJECTIVES: The aim of this study was to assess the impact of esomeprazole and famotidine on the efficacy of DAPT. MATERIAL AND METHODS: The study involved 160 patients undergoing elective percutaneous coronary interventions and treated with DAPT and concomitant use of esomeprazole (40 mg/d) or famotidine (40 mg/d). Platelet reactivity was measured with adenosine diphosphate (ADP)-induced light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation-platelet reactivity index (VASP-PRI) at baseline, 14 and 30 days after applying randomized acid-suppressing agents. RESULTS: No significance differences were observed in treatment-by-period interactions with LTA values (p = 0.298) and VASP-PRI values (p = 0.867), which suggested no carryover effect in either regimen over the 30-day treatment period. Intergroup comparisons were done between the 2 groups at 3 times, and similar findings were observed at each time (all p > 0.05). As for intragroup measurements among the separate times, significantly lower LTA and VASP-PRI values existed on day 14 for both agents (both p < 0.05). CONCLUSIONS: The antiplatelet effect of DAPT was not affected by concomitant use of esomeprazole or famotidine. These 2 agents were much less likely than CYP2C19 polymorphisms to influence aspirin/clopidogrel therapy, supporting the assertion that the pharmacodynamic interaction between aspirin/clopidogrel and acid-suppressing agents is a drug-specific rather than a class effect.
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Wu et al. (2019) conducted an RCT in Acute coronary syndromes (n=160). Esomeprazole vs. Famotidine (40 mg/day) was evaluated on ADP-induced light transmittance aggregometry (LTA) at 30 days (p=0.235). Concomitant use of esomeprazole or famotidine did not significantly differ in their effect on the antiplatelet efficacy of dual antiplatelet therapy at 30 days.
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