Therapeutic Response to Twice-daily Rabeprazole on Health-related Quality of Life and Symptoms in Patients with Refractory Reflux Esophagitis: A Multicenter Observational Study

Yoshikazu Kinoshita, Michio Hongo, Motoyasu Kusano, Yoshinori Furuhata, Hideaki Miyagishi, Satoshi Ikeuchi, RPZ Study Group, Yoshikazu Kinoshita, Michio Hongo, Motoyasu Kusano, Yoshinori Furuhata, Hideaki Miyagishi, Satoshi Ikeuchi, RPZ Study Group

Abstract

Objective To investigate the effect of twice-daily rabeprazole doses on health-related quality of life in refractory patients. Methods and Patients Reflux esophagitis patients with an insufficient response to once-daily proton pump inhibitor therapy (Los Angeles Classification grade A-D) received rabeprazole 10 mg or 20 mg twice daily for 8 weeks. The health-related quality of life (SF-8™) and symptoms, using the Frequency Scale for the Symptoms of Gastroesophageal reflux disease, were evaluated before treatment and at weeks 4 and 8. Endoscopy was performed at baseline and at weeks 8 and 32 where possible. The rabeprazole dose was determined by the attending physician. Results There were 1,796 patients analyzed for the efficacy of the twice-daily treatment. Of these cases, 1,462 were treated with rabeprazole 10 mg twice daily, and 334 were treated with rabeprazole 20 mg twice daily. The factors that affected the selection of the twice-daily rabeprazole dose by physicians were evaluated, and as expected, "endoscopic findings when treatment was started" had a strong effect on the selection of the rabeprazole dose. With both regimens, health-related quality of life and subjective symptoms were significantly improved at weeks 4 and 8 compared to baseline (p<0.001). The recurrence rate of erosive esophagitis at week 32 was 9.7% in rabeprazole twice daily-treated patients and 28.4% in proton pump inhibitor (PPI) once daily-treated patients. Both regimens were well tolerated. Conclusion Twice-daily treatment with rabeprazole improved the subjective symptoms and health-related quality of life in patients with refractory reflux esophagitis more effectively than the standard once-daily dose.

Keywords: quality of life; rabeprazole; refractory reflux esophagitis; twice daily.

Figures

Figure 1.
Figure 1.
Multivariate logistic analyses were performed to explore the patients’ characteristics with regard to selection of the RPZ b.i.d. dose. Treatment: 0: 10 mg b.i.d., 1: 20 mg b.i.d. †At baseline. *half: omeprazole 10 mg q.d., lansoprazole 15 mg q.d., esomeprazole 10 mg q.d., **double: rabeprazole 20 mg q.d.
Figure 2.
Figure 2.
Efficacy of rabeprazole 10 mg b.i.d. (a) Changes in the health-related quality of life (HRQOL) after beginning rabeprazole 10 mg b.i.d. treatment. (b) Changes in the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) score after beginning rabeprazole 10 mg b.i.d. treatment. (c) Endoscopically confirmed healing of reflux esophagitis after 8-week rabeprazole 10 mg b.i.d. treatment based on the Los Angeles Classification at baseline. W: week
Figure 3.
Figure 3.
Efficacy of rabeprazole 20 mg b.i.d. (a) Changes in the health-related quality of life (HRQOL) after beginning rabeprazole 20 mg b.i.d. treatment. (b) Changes in the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) score after beginning rabeprazole 20 mg b.i.d. treatment. (c) Endoscopically confirmed healing of reflux esophagitis after 8-week rabeprazole 20 mg b.i.d. treatment based on the Los Angeles Classification at baseline. W: week
Figure 4.
Figure 4.
Follow-up and recurrence of RE during maintenance therapy. (a) RE treatment status after 8 weeks of rabeprazole b.i.d. (b) RE recurrence rate after 32 weeks. RPZ b.i.d. includes both rabeprazole 10 mg b.i.d. and rabeprazole 20 mg b.i.d. PPI q.d. includes any PPI q.d. prescribed by attending physician.

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