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PubMed2006

The cost-effectiveness of lamotrigine in the maintenance treatment of adults with bipolar I disorder.

OBJECTIVE: To present an economic model and cost-effectiveness estimates for lamotrigine in maintenance treatment of bipolar I disorder (BD-I) using outcomes from the pivotal lamotrigine trials. The main comparator treatments in the pivotal trials were lithium and .no maintenance. (acute-only) treatment. A comparison with olanzapine was included as an indirect analysis following publication of data during the course of our research. METHODS: A Markov model was built around the 3 health states of euthymia, mania, and depression. The base-case model simulates a cohort of 1,000 patients with BD-I who have recently stabilized after resolution of a bipolar mania episode. The cohort was modeled for a period of 18 months. Resource-use estimates were derived from best available published data, treatment guidelines, a physician survey, and published unit cost data. Outputs were measured in terms of costs per acute mood episode avoided, costs per euthymic day gained, and costs per quality-adjusted life-years (QALYs). Direct health care payer costs are used in the analyses. RESULTS: The base-case model for patients with a recent manic episode indicated that lamotrigine is the most effective treatment for avoiding both acute depression episodes and all types of acute episodes (depression and mania). It is also the most effective treatment in terms of number of euthymic days achieved (309 days per patient per year). Olanzapine is most effective for avoiding acute mania episodes. Total direct costs of treatment are lowest for the lithium treatment arm (Dollars 8,710 per patient for the 18-month period). All maintenance therapies were cost effective compared with the no-maintenance (acute-only treatment) arm. In the base case, lamotrigine had incremental cost-effectiveness ratios of Dollars 30 per euthymic day and Dollars 2,400 per acute episode avoided compared with lithium. A QALY analysis indicated that lamotrigine is cost effective in patients with a recent manic episode at Dollars 26,000 per QALY. The base-case model indicated that lamotrigine dominates olanzapine, (that is, lamotrigine costs less and is more effective than olanzapine) in patients with a recent manic episode. In a sensitivity analysis using outcomes from the pivotal trial of recently depressed patients, lamotrigine, in comparison with lithium, was not shown to be as cost effective as in the recently manic patients, but it was still cost effective compared with no maintenance treatment. CONCLUSIONS: For a defined cohort of patients with BD-I, the pharmacoeconomic model indicated that prevention of mood episodes with lithium and lamotrigine is cost effective in patients with a recent manic, mixed, or hypomanic episode. The conclusions with respect to the indirect comparison with olanzapine should be validated if and when direct trial data become available. Cost-effectiveness of maintenance treatments for patients with BD-I (recently depressed as well as recently manic) are likely to improve in models with a broader costing perspective and that take a longer time frame. Further research into the outcome implications of health-related quality of life and other BD subgroups are recommended.

Adult↗
PubMed2004

Maintenance of remission in Crohn's disease: current and emerging therapeutic options.

Crohn's disease is a chronic inflammatory bowel disorder with a relapsing and remitting course. Once remission is achieved, the main aim of the management of Crohn's disease is maintenance of that remission. Significant advances have been made into understanding the aetiology and pathogenesis of inflammatory bowel disease. With these advances in understanding come increasing numbers of new agents and therapies, aimed both at active disease and the subsequent maintenance of remission in Crohn's disease. Current therapeutic strategies in maintaining remission in Crohn's disease include 5-aminosalicylates (e.g. sulfasalazine, mesalazine), thiopurines (e.g. azathioprine, 6-mercaptopurine [mercaptopurine]), methotrexate and infliximab. The 5-aminosalicylates appear to have efficacy limited to either surgically induced remission and/or limited small bowel Crohn's disease. The immunomodulators now have an established role in Crohn's maintenance. Azathioprine and 6-mercaptopurine are effective in chronic active disease and corticosteroid-dependent Crohn's disease. Methotrexate has similar indications, although it appears to be an alternative in patients who are intolerant of, or resistant to, the thiopurines. The most recent breakthrough has been in the field of biological therapy for maintenance of remission in Crohn's disease. Treatment of patients with the anti-tumour necrosis factor (TNF)-alpha antibody infliximab has been shown already to be effective in inducing remission. Recent studies have now confirmed a role for infliximab in delaying relapse and maintaining remission in patients responsive to infliximab induction therapy. However, results with soluble TNF alpha receptors have been disappointing. A number of other biological and nonbiological agents have shown potential, though trials of the 'newer' biological agents have thus far been disappointing, in the maintenance of remission in Crohn's disease. The evidence for theses agents is currently limited, in many cases to treating active disease; however, these data are discussed in this article in order to provide an overview of future potential therapies. The aim of this review is to provide clinicians with an insight into current and emerging therapeutic agents for the maintenance of remission of Crohn's disease.

Adjuvants, Immunologic↗
PubMed2000

Cost effectiveness of acute imipramine therapy versus two imipramine maintenance treatment regimens for panic disorder.

OBJECTIVE: To examine the medical costs and effectiveness of acute treatment with imipramine versus acute treatment plus 2 different maintenance therapies for panic disorder. METHODS: A clinical decision model was constructed to estimate 18-month costs and outcomes associated with these treatment scenarios based on the medical literature and clinician judgment. The clinical parameters and outcomes for the model were derived from a series of systematic clinical trials with imipramine utilising uniform dosage procedures and validated response criteria. Costs were calculated based on standardised treatment regimens. The outcome measures were 18-month medical costs, quality-adjusted life years (QALYs) and costs per QALY gained. A sensitivity analysis was performed to explore the impact of treatment withdrawals on outcomes. STUDY PERSPECTIVE: US mental healthcare system. RESULTS: Over 18 months, the total costs (1997 values) and QALYs associated with half-dose maintenance therapy (imipramine 1.1 mg/kg/day) [$US3377; QALYs = 0.991] and full-dose maintenance therapy (imipramine 2.25 mg/kg/ day) [$US3361; QALYs = 0.991] were almost identical; both were cost saving compared with acute imipramine therapy (2.25 mg/kg/day) with no maintenance treatment ($US3691; QALYs = 0.979). Whether patients withdrawing from treatment were considered to have continued to respond to treatment or to have relapsed, the half-dose and full-dose maintenance treatments were still cost saving compared with acute treatment alone. CONCLUSIONS: The results indicate that imipramine maintenance treatment is cost effective compared with acute imipramine treatment for patients with panic disorder. The basic findings and conclusions are not affected after modifying model assumptions for clinical response in patients withdrawing from treatment.

Clinical Trials as Topic↗
PubMed1984

Treatment collaboration of methadone maintenance programs and therapeutic communities.

Although they developed from different backgrounds, therapeutic communities and methadone maintenance programs became major treatments of heroin abuse in the 1970s. Research published in the last 5 years demonstrates that therapeutic communities are associated with long-lasting improvements in functioning for the few drug abusers who stay in treatment at least 3 months. A principal limitation of this modality is that few patients remain in treatment long enough to acquire the changed values that produce long-lasting effects. Research on methadone maintenance continues to show that this treatment produces immediate decreases in criminality and drug abuse; however, patients who taper off of maintenance are prone to relapse. The aspects of treatment that appear to prevent relapse include minimizing withdrawal symptoms during tapering and providing support during and after completing maintenance. The strengths of these two treatment modalities can be combined to enable narcotic addicts to taper off of methadone maintenance in a therapeutic community and remain drug-free. Several other clinical, administrative, and research collaborations could be beneficial, pooling the medical/technical expertise of maintenance programs with the intensity of therapeutic community treatment.

Combined Modality Therapy↗
PubMed1996

Methadone maintenance and addicts' risk of fatal heroin overdose.

An admission cohort of 296 Australian methadone maintenance patients was followed over 15 years. The relative risks of death in and out of maintenance were calculated for two age groups, 20-29 and 30-39 years. Heroin addicts in both age groups were one-quarter as likely to die while receiving methadone maintenance as addicts not in treatment. This is because they were significantly less likely to die by heroin overdose or suicide while in maintenance. Methadone maintenance had no measurable effect on the risk of death through nonheroin overdose, violence or trauma, or natural causes. A meta-analysis showed the reduction in overall mortality was consistent with the results of cohort studies conducted in the United States, Sweden, and Germany. The combined results of the five studies again indicated that methadone maintenance reduced addicts' risk of death to a quarter, RR 0.25 (95% CI 0.19 to 0.33).

Accidents↗
PubMed2000

[The financial impact of maintenance treatment in heroin addictive behavior: the case of Subutex].

BACKGROUND: The development of maintenance treatment for subjects with addictive behavior is an important public health issue. As such, the social effectiveness of maintenance products must be examined from an economical and social point of view. This paper aims at presenting the financial costs involved in the use of Subutex, a product commercialized since 1996. METHODS: A complete typology of costs related to drug addiction and its consequences was set up. Some of these costs were estimated on the basis of data drawn from the literature. The cost of Subutex use for maintenance treatment was assessed and compared with the financial stakes including the potential reduction of the economic and social cost of drug addiction. RESULTS: Monthly treatment cost of Subutex was 1252 FrF per drug abuser on maintenance treatment. By extrapolation, for a population of 40,000 drug abusers, the direct medical cost of Subutex during a course of maintenance treatment with general practitioner follow-up was estimated at 600 millions FrF. US data sources were applied to France to assess the cost of illnesses attributable to drug addiction. The cost reached 4.8 billions FrF. The cost of delinquency associated with drug addiction, which mostly concerns money laundered to purchase substances was an estimated 6.4 billions FrF. Finally, the cost of public anti-drug abuse programs was nearly 4.7 billions FrF. Thus, the direct cost of drug addiction consequences reached 15.6 billions FrF. This cost should be compared with the annual cost of Subutex for public organizations which was an estimated 600 millions FrF. CONCLUSIONS: The "profit" threshold of maintenance treatment with Subutex in terms of direct costs is very low. A decrease of only 4% of the costs associated with drug addiction would make it possible to balance the financial budget for the community. Our analysis does not take into acount absolutely all the public health and safety aspects involved in the use of Subutex. It does however provide a useful assessment of the financial aspects of the question and justification for this therapeutic strategy from a budgetary point of view.

Buprenorphine↗
PubMed2000

Acute myeloid leukemia in adults: is postconsolidation maintenance therapy necessary?

Maintenance treatment for patients with acute myeloid leukemia (AML) in remission has recently been controversially discussed and even abandoned by several groups. An analysis of 14 recently published multicenter trials, however, revealed the highest probabilities of relapse-free survival (RFS), in the range of 35% to 42% at 4 to 5 years, only in patients assigned to maintenance treatment as far as adult age and intent-to-treat conditions were considered. After having demonstrated a superior RFS rate from 3 years of maintenance after standard-dose consolidation compared with that from consolidation alone (P = .00004), the German AMLCG requestioned the effect of maintenance randomly compared with sequential high-dose cytosine arabinoside (Ara-C) and mitoxantrone in patients who received intensified induction treatment. The results show an advantage for maintenance treatment (RFS rate of 32%) versus the sequential Ara-C and mitoxantrone treatment (RFS rate of 25%) (P = .021). We conclude that maintenance treatment continues to substantially contribute to the management of adult patients with AML, even as part of recent strategies using intensified induction treatment, and thus appears necessary in these settings.

Acute Disease↗
PubMedDate not supplied

Mandibular overdentures: professional time for prosthodontic maintenance during the first year of service using three different implant systems.

PURPOSE: The purpose of this study was to evaluate the professional time required for the prosthodontic maintenance events of mandibular implant overdentures during the first year of service using three different implant systems (ITI, Steri-Oss, or Southern). MATERIALS AND METHODS: Seventy-two mandibular implant overdenture patients were allocated to three equal groups, each treated with a different implant system. Data on prosthodontic maintenance events during the first year were categorized and analyzed according to professional time allocation per procedure. RESULTS: The total professional time required to perform all the maintenance events ranged between 29.0 and 34.0 hours and did not differ significantly among the three groups, although there were time differences for matrix activation and replacement. When combining the professional time for all maintenance events for the mandibular overdentures alone, or with the opposing maxillary complete dentures, there were no significant differences between groups. For maintenance of the maxillary dentures, there was an unexplained difference between the Southern group and ITI or Steri-Oss groups (P < .05). CONCLUSION: The prosthodontic maintenance for mandibular implant overdentures required on average 72 to 98 minutes of professional time per patient during the first year of service, depending on the system used.

Aged↗
PubMed2004

[Economic efficiency of methadone maintenance and factors affecting it].

UNLABELLED: Methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse. Scientific literature describes that efficiency of methadone maintenance program depends on many factors. Our analysis is based on description of economic research methods and on factors affecting economic efficiency of methadone maintenance. METHODS: Computerized Medline data base was searched by key words: "economic evaluation", "cost-effectiveness", "cost-utility", "methadone", "methadone dosage", "ancillary services", "treatment duration". Review and analysis. RESULTS: Methadone maintenance therapy has higher economic efficiency with 80-100 mg per day methadone dose. Doses lower than 40 mg per day are considered as inefficient. Some methadone programs limit treatment to 90 days or less, but such short treatment episodes are not likely to be cost-effective. Ancillary services are more cost-effective at the beginning of methadone maintenance program, than in the later stages of the program. Economic efficiency is higher when program involves more participants, than when more ancillary services are provided. CONCLUSIONS. Effectiveness of Methadone maintenance program affects methadone dosage policy, treatment duration and ancillary services.

Cohort Studies↗
PubMed1988

Prolonged interval maintenance venom immunotherapy.

Current guidelines recommend indefinite administration of venom immunotherapy at 4-week intervals. To simplify this therapy, we examined the clinical and immunologic response after extending the interval between maintenance venom injections to 6, 8, and 12 weeks. Twenty-six patients who had had sting anaphylaxis and positive skin tests received maintenance bee or yellow jacket venom immunotherapy at greater or equal to 6-week intervals. This extended interval was started after a prior average 4-week maintenance interval of 2.3 years. Injections were given at 6-week intervals to all 26 patients and extended to 8-week intervals in 10, and 12-week intervals in 3 patients. Following venom injections, there were 14 mild local reactions and no systemic reactions. No adjustment in dosing was necessary. While on prolonged interval maintenance venom immunotherapy, there were 17 re-stings in 12 patients with no systemic reactions. During prolonged interval maintenance venom immunotherapy, either the serum venom-specific IgG increased or the already elevated titers remained the same in 18 patients and decreased in 2. In the others, preexisting titers were low and unchanged. Serum venom-specific IgE tended to slowly decrease. These clinical and immunologic data suggest that a 4-week maintenance interval may be safely extended.

Adolescent↗
PubMed1987

[Future perspectives for equipment maintenance and servicing].

Based on the Equipment Safety Law, the Medical Technical Regulations in force since 1 January 1986, and the German Standard DIN 13252: "Inhalational anesthetic Apparatus--requirements for safety and testing", a maintenance system for medical equipment is presented. The maintenance system comprises the check of the equipment by the user before clinical use, maintenance procedures when the equipment is in daily clinical use (maintenance system I), inspection of the equipment at fixed intervals (maintenance system II), and the repair of the equipment should it break down (maintenance system III). Possibilities and perspectives for rationalizing test procedures by means of test simulators are shown. The initial or repeated instruction on medical equipment with life-supporting functions can be performed more systematically when appropriately designed test simulators are used.

Anesthesiology↗
PubMedDate not supplied

Are steroids essential for successful maintenance of immunosuppression in heart transplantation?

To determine the necessity for maintenance dosages of prednisone in the management of heart transplant patients, a retrospective study was made of 86 patients undergoing orthotopic heart transplantation and two patients having heart-lung transplantation from June 1985 through October 1986. Group 1 (n = 52) had maintenance immunosuppressive therapy that included cyclosporine, azathioprine, and prednisone. Group 2 (n = 36) received only cyclosporine and azathioprine with no maintenance dosage of steroids. Data were analyzed for frequency of rejections, infections, noninfectious complications, and mortality. The rate of rejection was 1.44 episodes per patient in group 1 and 1.58 episodes per patient in group 2. Twenty of 52 patients (38%) in group 1 had no rejection compared with 12 of 36 patients (33%) in group 2 (p = not significant [NS]). One or more infections occurred in 30 patients (58%) in group 1, whereas only 12 patients (33%) in group 2 had infections (p less than 0.05). Noninfectious complication rates were noted to be similar in both groups (27% versus 25%, p = not significant). There were five deaths in group 1: three from infections, one from rejection, and one from trauma. There were three deaths in group 2: two from infection and one from rejection. Although 14 patients in group 2 eventually were placed on low-dosage steroid maintenance, the remaining 22 patients (61%) never received maintenance dosages of steroids. We conclude that some patients can be successfully managed without maintenance dosages of steroids after heart transplantation. Such patients do not appear to have an increased risk of rejection and may have a reduced rate of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Chemotherapy plays a major role in the inhibition of catch-up growth during maintenance therapy for childhood acute lymphoblastic leukemia.

OBJECTIVE: In children treated for acute lymphoblastic leukemia (ALL), catch-up growth occurs after cessation of therapy and not during maintenance therapy. In this study we investigated whether this inhibition of catch-up growth during maintenance treatment is attributable to the influence of chemotherapy or to the influence of corticosteroids. PATIENTS: Forty-six children treated for ALL were included in the study. In 27 patients maintenance therapy comprised vincristine (VCR), prednisone (Pred), or dexamethasone (Dexa) alternated with 6-mercaptopurine (6-MP) and methotrexate (MTX) and 19 patients received maintenance therapy with 6-MP and MTX only. Treatment did not include cranial irradiation. RESULTS: Statural growth during maintenance treatment was comparable in both groups over the study period of 1.5 years. CONCLUSION: Chemotherapy with 6-MP and MTX, and not corticosteroids, is the main factor that prevents catch-up growth from occurring during maintenance therapy for ALL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1975

[Gycoside serum concentrations under maintenance therapy with Lanicor, Card-Lamuran, MF708d, and Lanitop (author's transl)].

The biological availability of digitoxin from Lanicor was compared with that from two different galenical preparations of Card-Lamuran (Card-Lamuran and MF708d both containing equal amounts of active ingredients: 0,125 mg digitoxin and 10 mg raubasine). The patients who were kept on their individually adjusted oral digitoxin maintenance dosage received the three preparations in a randomised order. Additionally, the equivalent dosages of Lanicor and Lanitop were determined from the data on their biological availability. In 24 patients with heart failure (mean age 70.5 years), radioimmunoassay of the glycoside concentration in the serum was performed. The patients were cardially well compensated with Lanicor and it could be assumed that there would be no change in the daily maintenance dosage for the entire period of the study (42 days). Our results show that digitoxin had the same bio-availability from Lanicor and the two different galenical preparations of Card-Lamuran and MF708d. Patients can therefore safely be switched from one of these preparations to the other. On average, doses of Lanicor 1.55 times higher than those of Lanitop must be given to obtain the same serum glycoside concentrations. The variation of this factor was no greater than the variation in serum concentrations of digitoxin during continued maintenance therapy with Lanicor. The mean serum concentrations of digitoxin under maintenance therapy in our geriatric patients (mean value 2.1 mg/ml) were higher than the digitoxin concentrations published in the literature for younger patients (average 1.4 ng/ml). The calculated daily maintenance doses providing a digitoxin concentration of 1.4 mg/ml were ca. 0.3 mg Lanicor and ca. 0.2 mg Lanitop. This is somewhat less than generally assumed. This agrees with the clinical experience that the glycoside maintenance dosage in elderly patients is generally less than in middle-aged patients.

Age Factors↗
PubMed1996

Bidirectional regulation of protein kinase M zeta in the maintenance of long-term potentiation and long-term depression.

Long-term potentiation (LTP) and long-term depression (LTD) are persistent modifications of synaptic efficacy that may contribute to information storage in the CA1 region of the hippocampus. Persistently enhanced phosphorylation has been implicated in the maintenance phase of LTP. This hypothesis is supported by our previous observation that protein kinase M zeta (PKM zeta), the constitutively active catalytic fragment of a single protein kinase C isoform (PKC zeta), increases in LTP maintenance. In contrast, dephosphorylation may be important in LTD maintenance, because phosphatase inhibitors reverse established LTD, in addition to blocking its induction. Because phosphorylation is determined by a balance of phosphatases and kinases, both increases in phosphatase activity and decreases in kinase activity could contribute to LTD. We now report that the reduction of protein kinase activity by H7, as well as selective inhibition of PKC by chelerythrine, mimics and occludes the maintenance phase of homosynaptic LTD in rat hippocampal slices. Conversely, saturated LTD occludes the synaptic depression caused by chelerythrine. Biochemical analysis demonstrates a decrease of PKM zeta, as well as PKCs gamma and epsilon, in LTD maintenance and a concomitant loss of constitutive PKC activity. LTD and the downregulation of PKM zeta are prevented by NMDA receptor antagonists and Ca(2+)-dependent protease inhibitors. Both LTD and the downregulation of PKM zeta are reversible by high-frequency afferent stimulation. Our findings indicate that the molecular mechanisms of LTP and LTD maintenance are inversely related through the bidirectional regulation of PKC.

Alkaloids↗
PubMed1996

Maintenance therapy of persons with schizophrenia.

Developments over the past 20 years in maintenance treatment have substantially reduced problems with relapses, rehospitalization, and serious psychopathology and dysfunction for most patients with schizophrenia. Therapeutic gains can be accomplished with minimal dosing strategies, targeted drug therapy for medication-refusing patients, psychosocial interventions, and new drugs. Although minimal dose maintenance requires close clinical monitoring and effective collaboration, this strategy reduces side effects and negative symptoms and may thereby translate into greater medication compliance. Psychosocial therapeutics that include family intervention in conjunction with antipsychotic drug treatment reduce relapse rates, but further study is needed. Lithium, carbamazepine, benzodiazepines, beta-blockers, and antidepressant drugs along with electroconvulsive therapy and social skills training provide other relevant approaches in maintenance treatment. Before a maintenance role for new drugs such as clozapine and risperidone is clarified, controlled studies are needed. However, the advantages with motor side effects and secondary negative symptoms should enhance clinical course and medication compliance, and superior antipsychotic prophylaxis is hypothesized. Special issues in maintenance treatment include difficulty in predicting relapse, increased risk of adverse drug effects in elderly patients, and complication of the nonpsychotic aspects of schizophrenia by continued use of antipsychotic drugs. Optimal maintenance treatment incorporates early detection and outpatient management of symptom exacerbation, minimal dosing to increase compliance and reduce adverse effects, psychosocial intervention to reduce relapse rates and enhance functioning, and the integration of several therapeutic modalities and the provision of case managers and assertive community treatment teams.

Ambulatory Care↗
PubMed1997

[Cardiac surgery in patients with chronic renal failure on maintenance dialysis].

From July 1988 through August 1996, 54 patients with chronic renal failure (CRF) on maintenance dialysis (50 hemodialysis = HD, and 4 continuous ambulatory peritoneal dialysis) have undergone some sort of surgical procedure requiring the use of extra corporeal circulation (ECC); 42 patients underwent isolated coronary artery bypass grafting (CABG), 8 valve replacement, 3 combined procedures and 1 correction of a congenital heart defect. The protocol called for maintenance dialysis on the day before surgery, large volume hemofiltration (HF) during the ECC period, postoperative K+ management with dextrose-insulin if required, and resumption of whatever preoperative maintenance dialysis 24 hours after the operative procedure. The mean diafiltrate volume of HF was 7963 +/- 2688 ml which was replaced with 6342 +/- 2748 ml. No patient required emergency HD before the resumption of the maintenance dialysis, although in 40% of the early patients HD was added on the second postoperative day. However as experience was gained, in the latter 60% of patients resumption of maintenance dialysis (HD 3 times a week) was thought to be sufficient. The incidence of calcification in patients with CRF is higher not only of involved coronary artery segments (4.5 +/- 2.3 segments; AHA coronary classification) than its counterpart without CRF, but also of the ascending aorta which mandated modifications of the technique in 6 patients (operation under ventricular fibrillation, cannulation access other than ascending aorta). The use of arterial in situ conduits for CABG was also thought to be advantageous, and the left internal thoracic artery combined to the gastro-epiploic artery was used in 11 patients (26.2%). Four patients died) (7.4%): 2 from arrhythmia, one from intestinal necrosis and one from multiple cerebral infarction. Thus we conclude that the outlined protocol is quite effective in controlling fluid and electrolyte balance in patients on maintenance dialysis allowing to undertake surgical procedures requiring the use of extra corporeal circulation relatively safely.

Adult↗
PubMedDate not supplied

Omeprazole in patients with mild or moderate reflux esophagitis induces lower relapse rates than ranitidine during maintenance treatment.

BACKGROUND/AIMS: Patients with reflux esophagitis have rapid relapses after treatment withdrawal. This study was designed to investigate the relapse rate of symptomatic esophagitis during maintenance treatment with omeprazole versus ranitidine after the induction of acute healing with omeprazole. METHODOLOGY: Patients with endoscopically verified acute erosive or ulcerative esophagitis (grade 2 or 3) were initially treated with 20 mg of omeprazole daily for 4, 8, or 12 weeks. After healing, the patients were randomized to maintenance treatment with omeprazole (20 mg every morning) or ranitidine (150 mg twice daily). A control endoscopy was performed at the end of the healing phase and after 6 months of maintenance treatment or symptomatic relapse. RESULTS: Of 231 initially treated patients, 223 were healed (no erosive esophagitis) and entered the maintenance study. The estimated proportions of patients in remission after 6 months of maintenance treatment with 20 mg of omeprazole once per day (n = 102) and 150 mg of ranitidine twice per day (n = 103) were 89.2% and 75.7%, respectively. The single daily dose of omeprazole worked significantly better than the doses of ranitidine (p < 0.001). The omeprazole group, in comparison to the ranitidine group, had a significantly higher number of patients without symptoms (37.8% vs 54.7%) and a lesser percentage of moderate symptoms (9.45% vs 19.8%). CONCLUSIONS: Maintenance treatment with omeprazole (20 mg once daily) is superior to ranitidine (150 mg twice daily) in keeping patients with mild to moderate erosive reflux esophagitis in remission over a 6-month period.

Adolescent↗