Gastroesophageal Reflux Disease (GERD)
Conditions
Keywords
Gastroesophageal, Reflux, Disease, GERD
Brief summary
The purpose of this study is to compare the efficacy of rabeprazole extended release (ER) 50 mg (once daily) versus ranitidine 150 mg (twice daily) in the maintenance of complete healing in subjects with healed erosive gastroesophageal reflux disease (eGERD).
Detailed description
This is a multicenter, randomized, double-blind, double-dummy, parallel-group study. Subjects who meet all eligibility criteria will be randomly assigned to 1 of 2 treatment groups, RAB ER 50 mg (once daily) or Ranitidine 150 mg (twice daily).
Interventions
50 mg capsule, taken orally, once daily for 26 weeks.
150 mg capsule, taken orally, twice daily for 26 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
1\. Prior completion of Study E3810-G000-301 or -303. Subjects will need to have healed erosive esophagitis (absence of esophageal mucosal breaks or erosions) confirmed by EGD and sustained resolution of heartburn at Visit 4 or 5 of Study E3810-G000-301 or -303.
Exclusion criteria
1. Esophageal motility disorders (achalasia, scleroderma, or esophageal spasm). 2. Barrett's esophagus or esophageal stricture. 3. Use of prescription or non-prescription proton pump inhibitors (PPIs), histamine receptor antagonists (H2RA), antacids, sucralfate, misoprostol, prokinetics or drugs with significant anticholinergic effects throughout the study. 4. Subjects who require chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), oral steroids (\>= 20 mg/day prednisone or equivalent), or aspirin (-\>; 325 mg/day). 5. Significant hepatic, renal, respiratory, endocrine, hematologic, neurologic, psychiatric, or cardiovascular system abnormalities that would be likely to interfere with the conduct of the study, the interpretation of study results, or the health of the subject during the study. 6. Any condition that would make the subject, in the opinion of the investigator or sponsor, unsuitable for the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Maintenance of Complete Healing of eGERD at Week 26 | Baseline to Week 26 | eGERD (erosive gastroesophageal reflux disease) healing measured by the Time-to-Relapse of Oesophageal Erosions using an Esophagogastroduodenoscopy (EGD). Lesions were identified and graded using the following Los Angeles (LA) classification of Oesophagitis: 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 With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | Baseline to Week 26 | Heartburn or other GERD-associated symptoms (regurgitation, epigastric or chest pain, dysphagia, belching, bloating, early satiety, other) was based on a 4-point Likert scale that included the following: None (No symptoms); Mild (Awareness of symptoms but easily tolerated); Moderate (Discomforting symptom sufficient to cause interference with normal activities including sleep); Severe (Incapacitating symptom, inability to perform normal activities). |
| Percentage of Participants With Adverse Events by Category | From the time of administration of the first dose of study drug up to a maximum of approximately 30 weeks. | An adverse event (AE) was any untoward medical occurrence in a participant administered an investigational product. A treatment emergent AE (TEAE) was any AE beginning on or after the confirmed date of first dose of study medication, up to and including 7 days after the last dose of study medication. A TEAE was considered related to study treatment if a causal relationship between the study treatment and the AE was a reasonable possibility. AEs were graded as severe if they were incapacitating, with inability to work or to perform normal daily activity. Serious AEs (SAEs) were events that resulted in death, were life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, or were a congenital anomaly/birth defect. |
Countries
United States
Participant flow
Recruitment details
Participants were eligible for this study if they had completed one of the healing studies (E3810-G000-301 or E3810-G000-303), had no evidence of oesophageal erosions, had sustained heartburn resolution, and had no record of any serious adverse event (SAE) related to study medication during the healing study.
Pre-assignment details
Out of the 240 participants who were randomized in this study, 235 participants received study treatment.
Participants by arm
| Arm | Count |
|---|---|
| RAN 150mg BID Morning dose included 1 x Placebo to match RAB (Rabeprazole) ER (Extended Release) 50mg capsule and 1 x RAN (Ranitidine) 150mg capsule. Evening dose included 1 x RAN 150mg capsule. Received study drug orally daily for 26 weeks. | 59 |
| RAB ER 50mg QD Morning dose included 1 x RAB ER 50mg capsule and 1 x Placebo to match RAN 150mg capsule. Evening dose included 1 x Placebo to match RAN 150mg capsule. Received study drug orally daily for 26 weeks. | 176 |
| Total | 235 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 12 |
| Overall Study | Lack of Efficacy | 2 | 3 |
| Overall Study | Lost to Follow-up | 4 | 12 |
| Overall Study | Other | 11 | 7 |
| Overall Study | Withdrawal by Subject | 4 | 5 |
Baseline characteristics
| Characteristic | RAN 150mg BID | RAB ER 50mg QD | Total |
|---|---|---|---|
| Age, Customized | 46.7 Years STANDARD_DEVIATION 12.15 | 46.4 Years STANDARD_DEVIATION 12.83 | 46.5 Years STANDARD_DEVIATION 12.64 |
| Sex: Female, Male Female | 27 Participants | 81 Participants | 108 Participants |
| Sex: Female, Male Male | 32 Participants | 95 Participants | 127 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 59 | 0 / 176 |
| other Total, other adverse events | 8 / 59 | 43 / 173 |
| serious Total, serious adverse events | 1 / 59 | 10 / 173 |
Outcome results
Percentage of Participants With Maintenance of Complete Healing of eGERD at Week 26
eGERD (erosive gastroesophageal reflux disease) healing measured by the Time-to-Relapse of Oesophageal Erosions using an Esophagogastroduodenoscopy (EGD). Lesions were identified and graded using the following Los Angeles (LA) classification of Oesophagitis: 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 to Week 26
Population: Intent-to-Treat (ITT) Population - all randomized subjects who received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RAN 150mg BID | Percentage of Participants With Maintenance of Complete Healing of eGERD at Week 26 | 32.9 Percentage of Participants |
| RAB ER 50mg QD | Percentage of Participants With Maintenance of Complete Healing of eGERD at Week 26 | 84.9 Percentage of Participants |
Percentage of Participants With Adverse Events by Category
An adverse event (AE) was any untoward medical occurrence in a participant administered an investigational product. A treatment emergent AE (TEAE) was any AE beginning on or after the confirmed date of first dose of study medication, up to and including 7 days after the last dose of study medication. A TEAE was considered related to study treatment if a causal relationship between the study treatment and the AE was a reasonable possibility. AEs were graded as severe if they were incapacitating, with inability to work or to perform normal daily activity. Serious AEs (SAEs) were events that resulted in death, were life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, or were a congenital anomaly/birth defect.
Time frame: From the time of administration of the first dose of study drug up to a maximum of approximately 30 weeks.
Population: The safety population included all randomized participants who received at least one dose of study drug and had at least one post-baseline safety assessment. Analyses of the safety population was based on the actual treatment participants received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Any TEAE | 47.5 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Death | 0 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Severe TEAE | 3.4 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Other SAE | 1.7 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Treatment-related TEAE | 8.5 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Treatment-related SAE | 0 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | Severe, treatment-related TEAE | 1.7 Percentage of participants |
| RAN 150mg BID | Percentage of Participants With Adverse Events by Category | TEAEs leading to discontinuation of treatment | 6.8 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Severe, treatment-related TEAE | 0.6 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Any TEAE | 64.2 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Treatment-related TEAE | 14.5 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Severe TEAE | 8.1 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | TEAEs leading to discontinuation of treatment | 6.9 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Death | 0 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Other SAE | 6.4 Percentage of participants |
| RAB ER 50mg QD | Percentage of Participants With Adverse Events by Category | Treatment-related SAE | 0 Percentage of participants |
Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26
Heartburn or other GERD-associated symptoms (regurgitation, epigastric or chest pain, dysphagia, belching, bloating, early satiety, other) was based on a 4-point Likert scale that included the following: None (No symptoms); Mild (Awareness of symptoms but easily tolerated); Moderate (Discomforting symptom sufficient to cause interference with normal activities including sleep); Severe (Incapacitating symptom, inability to perform normal activities).
Time frame: Baseline to Week 26
Population: ITT
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| RAN 150mg BID | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | Yes | 8.5 Percentage of Participants |
| RAN 150mg BID | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | No | 25.4 Percentage of Participants |
| RAN 150mg BID | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | Missing | 66.1 Percentage of Participants |
| RAB ER 50mg QD | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | No | 18.8 Percentage of Participants |
| RAB ER 50mg QD | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | Yes | 57.4 Percentage of Participants |
| RAB ER 50mg QD | Percentage of Participants With Investigator-recorded Sustained Resolution of Heartburn at Week 26 | Missing | 23.9 Percentage of Participants |