Gastroesophageal Reflux Disease (GERD)
Conditions
Keywords
GERD, erosive GERD, erosive esophagitis
Brief summary
The purpose of this study is to investigate the efficacy (ie, healing and symptom relief) and safety of Rabeprazole Extended-Release (RAB ER) 50 mg versus Esomeprazole (ESO) 40 mg for the treatment of moderate to severe erosive Gastroesophageal Reflux Disease (eGERD).
Detailed description
This is a multicenter, randomized, double-blind, double-dummy, parallel-group study. Subjects who meet all the inclusion/exclusion criteria will be randomly assigned to 1 of 2 treatment groups, Rabeprazole Extended-Release (RAB ER) 50 mg or Esomeprazole (ESO) 40 mg for the treatment of moderate to severe erosive Gastroesophageal Reflux Disease (eGERD).
Interventions
DRUGRabeprazole sodium
Rabeprazole ER 50 mg capsule, once daily for 4-8 weeks.
DRUGEsomeprazole
Esomeprazole 40 mg capsule, once daily for 4-8 weeks.
Sponsors
Eisai Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
KEY INCLUSION CRITERIA: 1. Male or female, ages 18 to 75 years. 2. History of GERD symptoms for at least 3 months immediately before screening. 3. Heartburn for at least 2 days a week for at least 1 month before screening. 4. Esophageal erosions of LA Grades C or D based on EGD taken within 14 days prior to enrollment. 5. Subjects who are H. pylori negative based on a screening test. 6. Females should be either of non-childbearing potential or of childbearing potential. Females of childbearing potential must have negative pregnancy tests prior to randomization. Female subjects of childbearing potential must agree to use medically acceptable methods of contraception. 7. Subjects must be able to read, write, and understand the language of the symptom diary. KEY
Exclusion criteria
1. Current or a history of esophageal motility disorders. 2. Current or a history of Barrett's esophagus. 3. Current esophageal strictures or esophagitis (known or suspected to be due to etiology other than GERD such as infection or medications). 4. Current or a history of Zollinger-Ellison syndrome and other acid hypersecretory conditions, or current gastric or duodenal ulcer. 5. Current or a history of cancer, with the exception of fully excised skin basal cell carcinoma. 6. Inflammatory bowel disease. 7. Unstable diabetes mellitus. 8. History of esophageal, gastric and duodenal surgery except simple suturing of an ulcer. 9. Subjects who require daily use of nonsteroidal anti-inflammatory drugs (NSAIDs), oral steroids (\>= 20 mg/day prednisone or equivalent), or aspirin (\> 325 mg/day).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | Baseline and Week 8 | Healing at week 4 or 8 were based on improvement of eGERD of the Los Angeles (LA) classification of esophagitis Grade C or D from Baseline. Classifications include: Not Present: No breaks (erosions) in the esophageal mucosa (however, edema, erythema, or friability may be present) Grade A: One or more mucosal breaks not more than 5mm in maximum length. Grade B: One or more mucosal breaks more than 5mm in maximum length, but not continuous between the tops of 2 mucosal folds. Grade C: Mucosal breaks continuous between the tops of 2 or more mucosal folds, but involving less than 75% of the esophageal circumference. Grade D: Mucosal breaks involving at least 75% of the esophageal circumference. |
| Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | Baseline and Week 4 | Healing at week 4 or 8 were based on improvement of eGERD of the LA classification of esophagitis Grade C or D from Baseline. Classifications include: Not Present: No breaks (erosions) in the esophageal mucosa (however, edema, erythema, or friability may be present) Grade A: One or more mucosal breaks not more than 5mm in maximum length. Grade B: One or more mucosal breaks more than 5mm in maximum length, but not continuous between the tops of 2 mucosal folds. Grade C: Mucosal breaks continuous between the tops of 2 or more mucosal folds, but involving less than 75% of the esophageal circumference. Grade D: Mucosal breaks involving at least 75% of the esophageal circumference. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | Week 4 | During the first 4 weeks of the Double-blind Phase, participants were to record heartburn in a daily diary. Participant daily symptoms for the assessment of heartburn was based on a commonly used 4-point Likert scale of none, mild, moderate and severe. A participant was considered achieving sustained resolution of heartburn if the participant had maintained at least 7 consecutive heartburn-free days. |
Countries
Argentina, Australia, Bulgaria, Canada, Chile, Croatia, Estonia, France, Germany, Hungary, India, Latvia, Lithuania, United States
Participant flow
Pre-assignment details
Out of 1069 participants who were randomized, 1065 participants received study treatment.
Participants by arm
| Arm | Count |
|---|---|
| ESO 40mg Esomeprazole (ESO) 40mg capsule concurrently with placebo (identical in appearance to the RAB Extended Release (ER) 50mg capsule), once daily for 4 to 8 weeks. | 537 |
| RAB ER 50mg Rabeprazole (RAB) Extended Release (ER) 50mg capsule concurrently with placebo (identical in appearance to the ESO 40mg capsule), once daily for 4 to 8 weeks. | 528 |
| Total | 1,065 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 4 | 6 |
| Overall Study | Lost to Follow-up | 17 | 18 |
| Overall Study | Other | 7 | 8 |
| Overall Study | Withdrawal by Subject | 6 | 4 |
| Overall Study | Withdrawal of consent | 8 | 7 |
Baseline characteristics
| Characteristic | ESO 40mg | RAB ER 50mg | Total |
|---|---|---|---|
| Age, Continuous | 49.1 Years STANDARD_DEVIATION 13.38 | 51 Years STANDARD_DEVIATION 12.79 | 50 Years STANDARD_DEVIATION 13.12 |
| Sex: Female, Male Female | 195 Participants | 179 Participants | 374 Participants |
| Sex: Female, Male Male | 342 Participants | 349 Participants | 691 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 532 | 0 / 526 |
| serious Total, serious adverse events | 3 / 532 | 3 / 526 |
Outcome results
Primary
Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks
Healing at week 4 or 8 were based on improvement of eGERD of the LA classification of esophagitis Grade C or D from Baseline. Classifications include: Not Present: No breaks (erosions) in the esophageal mucosa (however, edema, erythema, or friability may be present) Grade A: One or more mucosal breaks not more than 5mm in maximum length. Grade B: One or more mucosal breaks more than 5mm in maximum length, but not continuous between the tops of 2 mucosal folds. Grade C: Mucosal breaks continuous between the tops of 2 or more mucosal folds, but involving less than 75% of the esophageal circumference. Grade D: Mucosal breaks involving at least 75% of the esophageal circumference.
Time frame: Baseline and Week 4
Population: ITT Population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ESO 40mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | Yes | 50.7 Percentage of Participants |
| ESO 40mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | No | 46.4 Percentage of Participants |
| ESO 40mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | Missing | 3 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | Yes | 50.9 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | No | 47 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With eGERD Who Achieved Endoscopically-confirmed Healing by 4 Weeks | Missing | 2.1 Percentage of Participants |
Primary
Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks
Healing at week 4 or 8 were based on improvement of eGERD of the Los Angeles (LA) classification of esophagitis Grade C or D from Baseline. Classifications include: Not Present: No breaks (erosions) in the esophageal mucosa (however, edema, erythema, or friability may be present) Grade A: One or more mucosal breaks not more than 5mm in maximum length. Grade B: One or more mucosal breaks more than 5mm in maximum length, but not continuous between the tops of 2 mucosal folds. Grade C: Mucosal breaks continuous between the tops of 2 or more mucosal folds, but involving less than 75% of the esophageal circumference. Grade D: Mucosal breaks involving at least 75% of the esophageal circumference.
Time frame: Baseline and Week 8
Population: ITT Population - all randomized subjects who received at least 1 dose of study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ESO 40mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | Yes | 78.4 Percentage of Participants |
| ESO 40mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | No | 16.6 Percentage of Participants |
| ESO 40mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | Missing | 5 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | Yes | 77.5 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | No | 18.4 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants With Erosive Gastroesophageal Reflux Disease (eGERD) Who Achieved Endoscopically-confirmed Healing by 8 Weeks | Missing | 4.2 Percentage of Participants |
Secondary
Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4
During the first 4 weeks of the Double-blind Phase, participants were to record heartburn in a daily diary. Participant daily symptoms for the assessment of heartburn was based on a commonly used 4-point Likert scale of none, mild, moderate and severe. A participant was considered achieving sustained resolution of heartburn if the participant had maintained at least 7 consecutive heartburn-free days.
Time frame: Week 4
Population: ITT Population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ESO 40mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | Yes | 52.5 Percentage of Participants |
| ESO 40mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | No | 40 Percentage of Participants |
| ESO 40mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | Missing | 7.4 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | Yes | 53.2 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | No | 39.6 Percentage of Participants |
| RAB ER 50mg | Percentage of Participants Who Achieved Diary-recorded Sustained Resolution of Heartburn by Week 4 | Missing | 7.2 Percentage of Participants |