Which Agent for Prevention of Duodenal Ulcer Recurrence? Low recurrence rates are seen with both cimetidine and ranitidine after 1 year, , ,

In a double· blind comparative trial 60 patients with chronic duodenal ulceration were randomlsed to prophylactic treatment \\<Ith oral ranltldlne 150mg once dally at night (n = 31) or oral clmetldine 400mg once dally at night (n = 13) for 1 year after ulcer healing with clmetldlne. Sixteen paltents were lost to follow up or withdrew from therapy 44 patients were evaluated

After 1 lear 26/31 ranltldlne·treated patients (84"/0) and 10/13 clmetldlne-treated patients (77%) had experienced no ulcer relapse Comparison of ulcer recurrence life tables for the 2 groups revealed no Significant differences between treatments and Independent variables such as sex, age, duration of symptoms, smoking and alcohol consumption had no Influence on ulcer recurrence, Ten and 15% of ranltldlne and Clmetldlne recIpients. respectively, remained symptomatic for a variable period in spite of ulcer healing. 34 patients who completed the study continued to receive open ranitidine therapy for a further 12 months; 87.5% remained healed during this period. Adverse effects reqUiring discontinuation of therapy were nausea (n = 1, ranitidine) and nausea and paraesthesia (n = 1, cimetidine).

The authors concluded that " , , ranltidine and cimetldine are effective and safe in the maintenance treatment of duodenal ulcer disease', Bolin TO. DaVIS AE. Billington B Journal of Clinical Gastroenterology 9 310·313. Jun 1987

... while pirenzepine reduces the relapse rate compared with placebo . .. In a randomised double-blind study evaluating the efficacy of pirenzepine 50mg bid for 1 year in the

prevention of duodenal ulcer relapse, patients from 3 centres received pirenzepine (n = 32) or placebo (31 ),

The relapse rate was significantly lower in pirenzepine-treated patients than in placebo-treated patients at 3 (28 and 58%, respectively), 6 (47 and 68%, respectively) and 12 months (53 and 71%, respectively). The mean success time of pirenzepine-treated patients was also significantly longer than that of placebo-treated patients (7.38 and 5.52 months, respectively), 20 pirenzepine-treated patients and 13 placebo-treated patients experienced adverse effects, the most frequent being dry mouth (14 and 5, respectively; p = 0.01).

Thus, pirenzepine is effective in reducing relapse rates over a 1-year period. Rutgeerts P. Vantrappen G. Brasslne A. Van Maercke Y Pen J. et al Journal of Clinical Gastroenterology 9 314·316, Jun 1987

... and sucralfate provides prophylaxis against symptomatic and asymptomatic ulcers In a randomised double-blind study, 84 patients with duodenal bulb ulcers received oral sucralfate 1 g

bid or placebo for 12 months. The number of evaluable patients in the two groups was 30 and 31, respectively, 23 of 31 placebo-treated patients (74%) and 6 of 30 sucralfate-treated patients (20%) showed ulcer recurrence within 6 months. At 12 months, 8 of 30 patients who received sucralfate (27%) and 25 of 31 placebo recipients (80%) showed ulcer recurrence (p = 0.0001 between treatments at both times). There were significant differences in favour of sucralfate in both smokers and non-smokers. Survival curves also showed sucralfate to be significantly more effective (p = 0.0001) in preventing ulcer relapse. Of those patients without symptomatic relapse at 6 months, significantly more ulcers were revealed by endoscopy in placebo recipients than in sucralfate recipients (8 vs 0). In both groups, a significant correlation was seen between symptom scores and the presence of ulcers.

The authors concluded that " , , sucralfate is superior to placebo in the prevention of recurrence of duodenal ulcer disease', Behar J, Roufall W. Thomas E, Keller F. Dernbach W, et al. Journal of Clinical Gastroenterology 9 (Suppl. 1) 23·30, 1987

0156·2703;87;0829·0009;0$01.00/0 © ADIS Press INPHARAfA' 29 August 1987 9