Esomeprazole in GERD Table 3 Randomized trials evaluating the efﬁcacy of esomeprazole vs other PPIs in combined endoscopic and symptomatic maintenance of healed erosive GERD Reference Study design Number of PPIs compared Maintenance rates at patients 6 months Lauritsen et al 2003 Double-blind, randomized 1224 Eso20 vs lan15 od 83 % vs 74%, p < 0.0001 Labenz et al 2005a Double-blind, randomized 2766 Eso20 vs panto20 od 87% vs 74.9%, p < 0.0001 Devault et al 2006 Double-blind, randomized 1026 Eso20 vs lan15 od 84.5% vs 75.9%, p < 0.0007 Notes: No randomized studies comparing esomeprazole with rabeprazole or omeprazole as to healing erosive GERD were found. Abbreviations: Eso, esomeprazole; lan, lansoprazole; panto, pantoprazole; PPI, proton-pump inhibitor. 15 mg (endoscopic maintenance rate: 84% vs 76%, p < 0.0002 (Lauritsen et al 2003); 84.5% vs 75.9%, p < 0.0001 (Devault et al 2006) or pantoprazole 20 mg (88.1% vs 76.6%, p < 0.0001 (Labenz et al 2005a)) od in maintaining endoscopic remission at 6 months. As regards maintenance of symptomatic remission only, one of these studies reported that esomeprazole 20 mg was more effective than lansoprazole 15 mg od (symptomatic remission maintenance rate: 78% vs 71%, p < 0.001 (Lauritsen et al 2003)) and another that esomeprazole 20 mg was more effective than pantoprazole 20 mg od (94.5% vs 90.5%, p < 0.0001 (Labenz et al 2005a)). However, the third study could not show any statistically signiﬁcant difference between esomeprazole and lansoprazole 15 mg od in maintaining symptomatic remission (76.4% vs 73%, p > 0.05) (Devault et al 2006). Lastly, studies comparing esomeprazole with lansoprazole showed that esomeprazole had consistently higher remission maintenance rates when patients were stratiﬁed according to initial severity of erosive GERD (Lauritsen et al 2003; Devault et al 2006). However, the study comparing esomeprazole 20 mg with pantoprazole 20 mg od reported that although esomeprazole had higher remission maintenance remission rates in patients with erosive GERD Los Angeles A–C, differences were not signiﬁcant in patients with Los Angeles D (Labenz et al 2005a). Although these data indicate superiority of esome- prazole compared with lansoprazole or pantoprazole in maintenance therapy of healed erosive GERD, there is a need for new clinical trials comparing esomeprazole with omeprazole and rabeprazole before deﬁnite conclusions can be drawn. Non-erosive GERD Patients with NERD may exhibit similar symptom severity to those with erosive GERD but as many as half of them may have a normal esophageal pH testing demonstrating pH values within the normal range of healthy subjects (Martinez et al 2003). Although PPIs have been shown to be effective in patients with NERD (Lind et al 1997), symptom Therapeutics and Clinical Risk Management 2007:3(4) improvement is lower compared with patients with erosive GERD (Martinez et al 2003). Three papers on clinical trials comparing continuous esomeprazole with other PPIs as therapy in NERD patients were identified. They all had a similar double-blind, randomized design, patients had a normal baseline endoscopy, intention-to-treat analysis of data was performed, and study duration was 4 weeks (Armstrong et al 2004; Fock et al 2005; Monnikes et al 2005). No study comparing continuous esomeprazole with lansoprazole therapy in NERD was identiﬁed. In one of these papers (Armstrong et al 2004), three studies were reported comparing A (n = 1282) esomeprazole 40 mg, esomeprazole 20 mg, or omeprazole 20 mg od; B (n = 693) esomeprazole 40 mg or omeprazole 20 mg od; and C (n = 670) esomeprazole 20 mg or omeprazole 20 mg od. Resolution of heartburn at 4 weeks (no heartburn symptoms during the last 7 days) was achieved in similar proportions of patients in each treatment arm in study A (esomeprazole 40 mg, 56.7%; esomeprazole 20 mg, 60.5%; omeprazole 20 mg, 58.1%), study B (esomeprazole 40 mg 70.3%; omeprazole 20 mg 67.9%), and study C (esomeprazole 20 mg 61.9%; omeprazole 20 mg, 59.6%). There were no signiﬁcant differences between treatment groups within each study. Thus, not only were esomeprazole and omeprazole treatments comparable but also esomeprazole 40 mg and esomeprazole 20 mg od did not yield signiﬁcantly different results after 4 weeks in patients with NERD (Armstrong et al 2004). Another clinical trial performed in Asian patients (n = 127) with NERD compared esomeprazole 20 mg with rabeprazole 10 mg od (Fock et al 2005). After 4 weeks of treatment the two PPIs were comparable for the primary endpoint of the study, ie, the time needed to achieve a 24-hour symptom-free interval for heartburn (esomeprazole 20 mg, 9 days; rabeprazole 10 mg, 8.5 days; p > 0.05) and regurgi- tation (esomeprazole 20 mg, 7.5 days; rabeprazole 10 mg, 6 days; p > 0.05). The authors reported that the two therapies 659