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PloS One 2016Antacid treatments decrease the serum concentrations of first-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs), although it is...
Antacid Use and De Novo Brain Metastases in Patients with Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Who Were Treated Using First-Line First-Generation Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors.
BACKGROUND
Antacid treatments decrease the serum concentrations of first-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs), although it is unknown whether antacids affect clinical outcomes. As cerebrospinal fluid concentrations of TKIs are much lower than serum concentrations, we hypothesized that this drug-drug interaction might affect the prognosis of patients with de novo brain metastases.
MATERIALS AND METHODS
This retrospective study evaluated 269 patients with EGFR-mutant non-small cell lung cancer (NSCLC) who had been diagnosed between December 2010 and December 2013, and had been treated using first-line first-generation EGFR-TKIs. Among these patients, we identified patients who concurrently used H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) as antacids. Patients who exhibited >30% overlap between the use of TKIs and antacids were considered antacid users.
RESULTS
Fifty-seven patients (57/269, 21.2%) were antacid users, and antacid use did not significantly affect progression-free survival (PFS; no antacids: 11.2 months, H2RAs: 9.4 months, PPIs: 6.7 months; p = 0.234). However, antacid use significantly reduced overall survival (OS; no antacids: 25.0 months, H2RAs: 15.5 months, PPIs: 11.3 months; p = 0.002). Antacid use did not affect PFS for various metastasis sites, although antacid users with de novo brain metastases exhibited significantly shorter OS, compared to non-users (11.8 vs. 16.3 months, respectively; p = 0.041). Antacid use did not significantly affect OS in patients with bone, liver, or pleural metastases.
CONCLUSION
Antacid use reduced OS among patients with EGFR-mutant NSCLC who were treated using first-line first-generation EGFR-TKIs, and especially among patients with de novo brain metastases.
Topics: Aged; Antacids; Antineoplastic Agents; Brain Neoplasms; Carcinoma, Non-Small-Cell Lung; Drug Interactions; ErbB Receptors; Female; Humans; Male; Mutation; Protein Kinase Inhibitors; Retrospective Studies
PubMed: 26894507
DOI: 10.1371/journal.pone.0149722 -
Alimentary Pharmacology & Therapeutics Jul 2002GERD prevalence continues to rise in contrast to peptic ulcer disease. The spectrum contains reflux esophagitis and so-called 'endoscopy-negative GERD' or 'non-erosive... (Review)
Review
GERD prevalence continues to rise in contrast to peptic ulcer disease. The spectrum contains reflux esophagitis and so-called 'endoscopy-negative GERD' or 'non-erosive GERD' (NERD) or S-GERD and patients with 'normal' overall 24-h esophageal acidification but with a high 'symptom-index'. The majority of reflux patients will not need endoscopy initially. Prompt referral for endoscopy is indicated only if the patient has atypical symptoms or alarm symptoms such as dysphagia, anemia, weight loss, severe abdominal pain, or pain that does not respond to acid neutralization or suppression, or develops symptoms after the age of 50 years. Antireflux therapy consist of raising the head of the bed, maintaining normal weight, and avoidance of foods and drugs that precipitate symptoms, together with antacids or over-the-counter H(2) receptor antagonists (H(2)RAs). If symptoms persist after these simple measures or if antacids or H(2)RAs are needed quite often, then a more formal first-line treatment should be started. Many experts feel that a stepdown approach instead of a stepup approach is clinically and economically a more appropriate way of installing such first-line therapy. Physicians increasingly consider prescribing a (low- or standard dose) once-a-day proton pump inhibitor (PPI) as firstline therapy. If symptoms recur after 4-week trial or are in sufficiently relieved, then the patient should be referred for endoscopy. Endoscopy may reveal no abnormalities (NERD) or evidence of reflux-induced damage. Treatment of endoscopy-negative reflux disease should be directed towards rapid relief of symptoms and then maintenance of relief using minimum effective therapy. Responses to PPIs are somewhat lower in endoscopy-negative patients compared to esophagitis. Some form of long-term therapy is needed in the majority of patients. 'On demand' PPI therapy to control reflux symptoms is a new and attractive option. The goal of treatment of GERD should be to relieve symptoms and to heal lesions. Symptom severity and much less endoscopic abnormalities, drives the therapy. When symptoms are mild or intermittent and when esophagitis is absent or minimal, standard dose PPI is usually reinstituted. If there is moderate or severe esophagitis or if symptoms are particularly troublesome, then the patient should start again with standard-dose PPI therapy once a day, but not uncommonly a b.i.d. dosage maybe necessary. Once a dose of the acid suppressant that relieves symptoms is found, this dose should be maintained for a period of 3 months. After this time, an attempt should be made to reduce the dose. A plan should be formulated for long-term treatment.
Topics: Antacids; Gastroesophageal Reflux; Gastrointestinal Agents; Histamine H2 Antagonists; Humans; Life Style; Proton Pump Inhibitors; Self Medication
PubMed: 12047264
DOI: 10.1046/j.1365-2036.16.s4.11.x -
Alimentary Pharmacology & Therapeutics Aug 1999Patients with acid-related diseases often need to take multiple medications. Treatment of Helicobacter pylori infection often includes either a histamine type 2... (Review)
Review
Patients with acid-related diseases often need to take multiple medications. Treatment of Helicobacter pylori infection often includes either a histamine type 2 (H2)-receptor antagonist or a proton pump (H+,K(+)-ATPase) inhibitor (proton pump inhibitor), administered in conjunction with one or more antimicrobials. Also, treatment for acid-related diseases often requires extended therapy during which many concomitant medications may be administered for concurrent disease states. Polypharmacy may be the result, particularly in elderly patients, who are at increased risk for both acid-related and many other diseases. Thus, it is important to understand the potential for clinically significant drug-drug interactions in this setting. H2-receptor antagonists and proton pump inhibitors can influence the pharmacokinetic profiles of other commonly administered medications by elevating intragastric pH, which can alter drug absorption, and by interacting with the cytochrome P (CYP) 450 enzyme system, which can affect drug metabolism and clearance. Such interactions are particularly important when they affect the pharmacokinetics of drugs with narrow therapeutic ranges (e.g. warfarin, digoxin). In these cases, drug-drug interactions can result in significant toxicity and even death. There are marked differences among H2-receptor antagonists and proton pump inhibitors in their potential for such interactions. The oldest drugs in each class, cimetidine and omeprazole, respectively, have the greatest potential to alter CYP activity and change the pharmacokinetics of other drugs. The most recently developed H2-receptor antagonist, famotidine, and the newer proton pump inhibitors, rabeprazole and pantoprazole, are much less likely to induce or inhibit CYP and thereby change the metabolism of other medications. These differences are important when choosing medications for the safe treatment of patients with acid-related diseases.
Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Antacids; Anti-Ulcer Agents; Benzimidazoles; Drug Interactions; Enzyme Inhibitors; Humans; Omeprazole; Proton Pump Inhibitors; Rabeprazole
PubMed: 10491725
DOI: 10.1046/j.1365-2036.1999.00021.x -
Alimentary Pharmacology & Therapeutics Sep 2001The pathophysiology of recurrent postprandial heartburn and the basis for the effectiveness of antacids or low doses of histamine H2-receptor antagonists have not been... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
The pathophysiology of recurrent postprandial heartburn and the basis for the effectiveness of antacids or low doses of histamine H2-receptor antagonists have not been well studied.
METHODS
The selected subjects (n=26) had heartburn more than four times a week for at least 2 months, which was responsive to antacids. Gastric pH and oesophageal pH were measured for 1 h before, during, and 4.5 h after ingestion of a meal over 0.5 h. Heartburn severity was assessed at 15-min intervals beginning at the end of the meal. Each subject randomly received placebo, 75 mg ranitidine, 420 mg calcium carbonate, and ranitidine plus calcium carbonate. Values for pH were converted to acid concentration (mM) and integrated acidity was calculated from the cumulative, time-weighted means of the acid concentrations for every second of the postprandial recording period.
RESULTS
There was a close temporal relationship between heartburn and oesophageal acidity. Most oesophageal acid exposure occurred over a 90-min period that began approximately 45 min after the end of the meal. During this period the gastric acid concentration was less than 5% of maximal. Ranitidine significantly decreased gastric but not oesophageal acidity, whilst antacid significantly decreased oesophageal but not gastric acidity. Ranitidine plus antacid significantly decreased both gastric and oesophageal acidity. Antacid alone and ranitidine plus antacid significantly decreased heartburn severity.
CONCLUSIONS
Determining integrated gastric and oesophageal acidity provides novel information regarding the pathophysiology of meal-induced heartburn as well as the actions of low-dose ranitidine and antacid. For subjects with meal-induced heartburn, treatment with low-dose ranitidine plus antacid is particularly effective in decreasing gastric and oesophageal acidity as well as heartburn severity.
Topics: Antacids; Anti-Ulcer Agents; Cross-Over Studies; Drug Synergism; Eating; Female; Gastric Acid; Heartburn; Humans; Hydrogen-Ion Concentration; Male; Pain Measurement; Ranitidine; Severity of Illness Index
PubMed: 11552907
DOI: 10.1046/j.1365-2036.2001.01058.x -
Alimentary Pharmacology & Therapeutics Jun 2020Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomised clinical trial: the effectiveness of Gaviscon Advance vs non-alginate antacid in suppression of acid pocket and post-prandial reflux in obese individuals after late-night supper.
BACKGROUND
Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD.
AIMS
To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants.
METHODS
Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.
RESULTS
Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m ) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P < 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1 (all P < 0.05).
CONCLUSIONS
Among obese individuals, Gaviscon Advance was superior to a non-alginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188).
Topics: Adult; Alginates; Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Drug Combinations; Female; Gastric Acid; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Malaysia; Male; Meals; Middle Aged; Obesity; Postprandial Period; Silicic Acid; Sodium Bicarbonate; Time Factors; Treatment Outcome; Young Adult
PubMed: 32343001
DOI: 10.1111/apt.15746 -
BMJ (Clinical Research Ed.) Sep 2000To evaluate efficacy and cost effectiveness of Helicobacter pylori eradication treatment in patients with non-ulcer dyspepsia infected with H pylori. (Comparative Study)
Comparative Study Review
OBJECTIVES
To evaluate efficacy and cost effectiveness of Helicobacter pylori eradication treatment in patients with non-ulcer dyspepsia infected with H pylori.
DESIGN
Systematic review of randomised controlled trials comparing H pylori eradication with placebo or another drug treatment. Results were incorporated into a Markov model comparing health service costs and benefits of H pylori eradication with antacid treatment over one year.
DATA SOURCES
Six electronic databases were searched for randomised controlled trials from January 1966 to May 2000. Experts in the field, pharmaceutical companies, and journals were contacted for information on any unpublished trials. Trial reports were reviewed according to predefined eligibility and quality criteria.
MAIN OUTCOME MEASURES
Relative risk reduction for remaining dyspeptic symptoms (the same or worse) at 3-12 months. Cost per dyspepsia-free month estimated from Markov model based on estimated relative risk reduction.
RESULTS
Twelve trials were included in the systematic review, nine of which evaluated dyspepsia at 3-12 months in 2541 patients. H pylori eradication treatment was significantly superior to placebo in treating non-ulcer dyspepsia (relative risk reduction 9% (95% confidence interval 4% to 14%)), one case of dyspepsia being cured for every 15 people treated. H pylori eradication cost pound56 per dyspepsia-free month during first year after treatment.
CONCLUSION
H pylori eradication may be cost effective treatment for non-ulcer dyspepsia in infected patients but further evidence is needed on decision makers' willingness to pay for relief of dyspepsia.
Topics: Antacids; Anti-Bacterial Agents; Cost-Benefit Analysis; Drug Costs; Dyspepsia; Helicobacter Infections; Helicobacter pylori; Humans; Information Storage and Retrieval; Markov Chains; Randomized Controlled Trials as Topic; Risk
PubMed: 10987767
DOI: 10.1136/bmj.321.7262.659 -
Alimentary Pharmacology & Therapeutics Jan 1998Dyspepsia is common within the general population and it imposes a significant burden on health-care resources. Calculation of the economic implications of functional... (Comparative Study)
Comparative Study Review
Dyspepsia is common within the general population and it imposes a significant burden on health-care resources. Calculation of the economic implications of functional dyspepsia is constrained by the fact that it is only possible to make this diagnosis in a minority of individuals with the disorder, because many do not seek medical attention and investigation is not appropriate for all who do. Studies which attempt to assess the effectiveness or cost-effectiveness of therapy may be further constrained by the fact that there is now good evidence that many patients with dyspepsia seek medical attention not so much because of the severity of symptoms, but because they fear that the symptoms signal the presence of some serious underlying disease. In this situation, effective well-founded reassurance that no serious disease is present is an important outcome of medical intervention and one which should be included in an economic appraisal of dyspepsia management. For obvious reasons, it is sensible to compare the cost-effectiveness of various clinical management strategies applicable in dyspepsia. Decision-tree analyses are currently fashionable but suffer from the major defect that there is no theoretical basis from which patient satisfaction with treatment options can be assessed. It is suggested that for disorders such as functional dyspepsia, which are non-lethal and non-progressive, recommendations about acceptable clinical management strategies require that account be taken of patient satisfaction with the strategies being reviewed. Cost-effectiveness calculations which take no account of this aspect of outcome are of limited relevance to clinical practice.
Topics: Antacids; Cost-Benefit Analysis; Dyspepsia; Gastrointestinal Motility; Helicobacter pylori; Histamine H2 Antagonists; Humans; Physician-Patient Relations; Risk Factors
PubMed: 9692695
DOI: 10.1046/j.1365-2036.1998.00261.x -
BMC Health Services Research Nov 2007Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD). (Review)
Review
BACKGROUND
Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD).
METHODS
A systematic review of intervention studies with a design according to research quality criteria and outcomes related to the effect of reduction of ASD medication retrieved from Medline, Embase and the Cochrane Library. Outcome measures were the strategy of intervention, quality of methodology and results of treatment to differences of ASD prescriptions and costs.
RESULTS
The intervention varied from a single passive method to multiple active interactions with GPs. Reports of study quality had shortcomings on subjects of data-analysis. Not all outcomes were calculated but if so rction of prescriptions varied from 8% up to 40% and the cost effectiveness was in some cases negative and in others positive. Few studies demonstrated good effects from the interventions to reduce ASD.
CONCLUSION
Poor quality of some studies is limiting the evidence for effective interventions. Also it is difficult to compare cost-effectiveness between studies. However, RCT studies demonstrate that active interventions are required to reduce ASD volume. Larger multi-intervention studies are necessary to evaluate the most successful intervention instruments.
Topics: Antacids; Cost-Benefit Analysis; Drug Utilization; Dyspepsia; Gastroesophageal Reflux; Health Plan Implementation; Humans; Outcome and Process Assessment, Health Care; Proton Pump Inhibitors; Proton Pumps
PubMed: 17983477
DOI: 10.1186/1472-6963-7-177 -
Cleveland Clinic Journal of Medicine 1987
Topics: Adult; Aluminum Hydroxide; Antacids; Drug Combinations; Female; Humans; Magnesium; Magnesium Hydroxide; Osteomalacia; Peptic Ulcer
PubMed: 3608134
DOI: 10.3949/ccjm.54.3.214 -
Minerva Gastroenterologica E Dietologica Sep 2004Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders, and the pharmacological management of GERD is a topic of intense interest... (Review)
Review
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders, and the pharmacological management of GERD is a topic of intense interest given the sizeable yearly expenditure for antireflux therapies. GERD is primarily a motor disorder of the esophagus, yet pharmacological approaches directed at altering esophageal motility have been only partially effective. Antisecretory therapy is the mainstay of treatment for GERD. Both H2 receptor antagonists (H2RA) and proton pump inhibitors (PPIs) are effective in the treatment of GERD, but PPI therapy is clearly superior in the treatment of severe disease and in the healing of erosive esophagitis. A treatment schema for GERD based on presenting symptoms is outlined, promoting a stepwise approach to the appropriate use of antisecretory therapy.
Topics: Antacids; Drug Administration Schedule; Drug Therapy, Combination; Gastroesophageal Reflux; Gastrointestinal Agents; Gastrointestinal Transit; Histamine H2 Antagonists; Humans; Life Style; Proton Pump Inhibitors
PubMed: 15729198
DOI: No ID Found