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Published in: Digestive Diseases and Sciences 11/2017

Open Access 01-11-2017 | Original Article

Dexlansoprazole for Heartburn Relief in Adolescents with Symptomatic, Nonerosive Gastro-esophageal Reflux Disease

Authors: Benjamin D. Gold, Betsy Pilmer, Jaroslaw Kierkuś, Barbara Hunt, Maria Claudia Perez, David Gremse

Published in: Digestive Diseases and Sciences | Issue 11/2017

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Abstract

Background

Proton pump inhibitors are commonly used to treat gastro-esophageal reflux disease (GERD) and nonerosive GERD (NERD) in adolescents and adults. Despite the efficacy of available medications, many patients have persisting symptoms, indicating a need for more effective agents.

Aims

To assess the safety and efficacy of dexlansoprazole dual delayed-release capsules in adolescents for treatment of symptomatic NERD.

Methods

A phase 2, open-label, multicenter study was conducted in adolescents aged 12–17 years. After a 21-day screening period, adolescents with endoscopically confirmed NERD received a daily dose of 30-mg dexlansoprazole for 4 weeks. The primary endpoint was treatment-emergent adverse events (TEAEs) experienced by ≥5% of patients. The secondary endpoint was the percentage of days with neither daytime nor nighttime heartburn. Heartburn symptoms and severity were recorded daily in patient electronic diaries and independently assessed by the investigator, along with patient-reported quality of life, at the beginning and end of the study.

Results

Diarrhea and headache were the only TEAEs reported by ≥5% of patients. Dexlansoprazole-treated patients (N = 104) reported a median 47.3% of days with neither daytime nor nighttime heartburn. Symptoms such as epigastric pain, acid regurgitation, and heartburn improved in severity for 73–80% of patients. Pediatric Gastroesophageal Symptom and Quality of Life Questionnaire-Adolescents-Short Form symptom and impact subscale scores (scaled 1–5) each decreased by an average of 0.7 units at week 4.

Conclusions

Use of 30-mg dexlansoprazole in adolescent NERD was generally well tolerated and had beneficial effects on improving heartburn symptoms and quality of life.

Trial Registration

This study has the ClinicalTrials.gov identifier NCT01642602.
Appendix
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Literature
1.
go back to reference Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498–547.CrossRefPubMed Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498–547.CrossRefPubMed
2.
go back to reference El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–880.CrossRefPubMed El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–880.CrossRefPubMed
3.
go back to reference Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259–1268.CrossRefPubMed Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259–1268.CrossRefPubMed
4.
go back to reference Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–1456.CrossRefPubMed Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–1456.CrossRefPubMed
5.
go back to reference Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–649.CrossRefPubMed Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–649.CrossRefPubMed
6.
go back to reference El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–1699.CrossRefPubMed El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–1699.CrossRefPubMed
8.
go back to reference Sugimoto M, Nishino M, Kodaira C, et al. Characteristics of non-erosive gastroesophageal reflux disease refractory to proton pump inhibitor therapy. World J Gastroenterol. 2011;17:1858–1865.PubMedPubMedCentral Sugimoto M, Nishino M, Kodaira C, et al. Characteristics of non-erosive gastroesophageal reflux disease refractory to proton pump inhibitor therapy. World J Gastroenterol. 2011;17:1858–1865.PubMedPubMedCentral
9.
go back to reference Guimaraes EV, Guerra PV, Penna FJ. Management of gastroesophageal reflux disease and erosive esophagitis in pediatric patients: focus on delayed-release esomeprazole. Ther Clin Risk Manag. 2010;6:531–537.CrossRefPubMedPubMedCentral Guimaraes EV, Guerra PV, Penna FJ. Management of gastroesophageal reflux disease and erosive esophagitis in pediatric patients: focus on delayed-release esomeprazole. Ther Clin Risk Manag. 2010;6:531–537.CrossRefPubMedPubMedCentral
12.
go back to reference Jones R. Gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol Suppl. 1995;211:35–38.CrossRefPubMed Jones R. Gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol Suppl. 1995;211:35–38.CrossRefPubMed
13.
go back to reference Seo GS, Jeon BJ, Chung JS, et al. The prevalence of erosive esophagitis is not significantly increased in a healthy Korean population—could it be explained? A multi-center prospective study. J Neurogastroenterol Motil. 2013;19:70–77.CrossRefPubMedPubMedCentral Seo GS, Jeon BJ, Chung JS, et al. The prevalence of erosive esophagitis is not significantly increased in a healthy Korean population—could it be explained? A multi-center prospective study. J Neurogastroenterol Motil. 2013;19:70–77.CrossRefPubMedPubMedCentral
14.
go back to reference Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut. 2012;61:1390–1397.CrossRefPubMed Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut. 2012;61:1390–1397.CrossRefPubMed
15.
go back to reference Gold BD, Freston JW. Gastroesophageal reflux in children: pathogenesis, prevalence, diagnosis, and role of proton pump inhibitors in treatment. Paediatr Drugs. 2002;4:673–685.CrossRefPubMed Gold BD, Freston JW. Gastroesophageal reflux in children: pathogenesis, prevalence, diagnosis, and role of proton pump inhibitors in treatment. Paediatr Drugs. 2002;4:673–685.CrossRefPubMed
16.
go back to reference Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 2000;154:150–154.CrossRefPubMed Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 2000;154:150–154.CrossRefPubMed
17.
go back to reference Chen JH, Wang HY, Lin HH, Wang CC, Wang LY. Prevalence and determinants of gastroesophageal reflux symptoms in adolescents. J Gastroenterol Hepatol. 2014;29:269–275.CrossRefPubMed Chen JH, Wang HY, Lin HH, Wang CC, Wang LY. Prevalence and determinants of gastroesophageal reflux symptoms in adolescents. J Gastroenterol Hepatol. 2014;29:269–275.CrossRefPubMed
18.
go back to reference Nelson SP, Kothari S, Wu EQ, Beaulieu N, McHale JM, Dabbous OH. Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy. J Med Econ. 2009;12:348–355.CrossRefPubMed Nelson SP, Kothari S, Wu EQ, Beaulieu N, McHale JM, Dabbous OH. Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy. J Med Econ. 2009;12:348–355.CrossRefPubMed
19.
go back to reference Siegel PD, Katz J. Respiratory complications of gastroesophageal reflux disease. Prim Care. 1996;23:433–441.CrossRefPubMed Siegel PD, Katz J. Respiratory complications of gastroesophageal reflux disease. Prim Care. 1996;23:433–441.CrossRefPubMed
20.
go back to reference Gunasekaran TS, Dahlberg M. Prevalence of gastroesophageal reflux symptoms in adolescents: is there a difference in different racial and ethnic groups? Dis Esophagus. 2011;24:18–24.CrossRefPubMed Gunasekaran TS, Dahlberg M. Prevalence of gastroesophageal reflux symptoms in adolescents: is there a difference in different racial and ethnic groups? Dis Esophagus. 2011;24:18–24.CrossRefPubMed
21.
go back to reference Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician. 2001;64:1853–1860.PubMed Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician. 2001;64:1853–1860.PubMed
22.
go back to reference Koebnick C, Getahun D, Smith N, Porter AH, Der-Sarkissian JK, Jacobsen SJ. Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes. 2011;6:e257–e263.CrossRefPubMed Koebnick C, Getahun D, Smith N, Porter AH, Der-Sarkissian JK, Jacobsen SJ. Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes. 2011;6:e257–e263.CrossRefPubMed
23.
go back to reference Waring JP, Feiler MJ, Hunter JG, Smith CD, Gold BD. Childhood gastroesophageal reflux symptoms in adult patients. J Pediatr Gastroenterol Nutr. 2002;35:334–338.CrossRefPubMed Waring JP, Feiler MJ, Hunter JG, Smith CD, Gold BD. Childhood gastroesophageal reflux symptoms in adult patients. J Pediatr Gastroenterol Nutr. 2002;35:334–338.CrossRefPubMed
25.
go back to reference El-Serag HB, Gilger M, Carter J, Genta RM, Rabeneck L. Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol. 2004;99:806–812.CrossRefPubMed El-Serag HB, Gilger M, Carter J, Genta RM, Rabeneck L. Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol. 2004;99:806–812.CrossRefPubMed
26.
go back to reference van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. 2011;127:925–935.CrossRefPubMed van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. 2011;127:925–935.CrossRefPubMed
27.
go back to reference Tsou VM, Baker R, Book L, et al. Multicenter, randomized, double-blind study comparing 20 and 40 mg of pantoprazole for symptom relief in adolescents (12 to 16 years of age) with gastroesophageal reflux disease (GERD). Clin Pediatr (Phila). 2006;45:741–749.CrossRef Tsou VM, Baker R, Book L, et al. Multicenter, randomized, double-blind study comparing 20 and 40 mg of pantoprazole for symptom relief in adolescents (12 to 16 years of age) with gastroesophageal reflux disease (GERD). Clin Pediatr (Phila). 2006;45:741–749.CrossRef
28.
go back to reference Gold BD, Gunasekaran T, Tolia V, et al. Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007;45:520–529.CrossRefPubMed Gold BD, Gunasekaran T, Tolia V, et al. Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007;45:520–529.CrossRefPubMed
29.
go back to reference Haddad I, Kierkus J, Tron E, et al. Efficacy and safety of rabeprazole in children (1–11 years) with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2013;57:798–807.CrossRefPubMed Haddad I, Kierkus J, Tron E, et al. Efficacy and safety of rabeprazole in children (1–11 years) with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2013;57:798–807.CrossRefPubMed
30.
go back to reference Eisai. Aciphex (rabeprazole) delayed release tablets. Full prescribing information. In: Eisai Pharmaceuticals I, ed., Tokyo; 2009. Eisai. Aciphex (rabeprazole) delayed release tablets. Full prescribing information. In: Eisai Pharmaceuticals I, ed., Tokyo; 2009.
31.
go back to reference Lee JH, Kim MJ, Lee JS, Choe YH. The effects of three alternative treatment strategies after 8 weeks of proton pump inhibitor therapy for GERD in children. Arch Dis Child. 2011;96:9–13.CrossRefPubMed Lee JH, Kim MJ, Lee JS, Choe YH. The effects of three alternative treatment strategies after 8 weeks of proton pump inhibitor therapy for GERD in children. Arch Dis Child. 2011;96:9–13.CrossRefPubMed
32.
go back to reference Takeda. Dexilant (dexlansoprazole) delayed release capsules. Full prescribing information. In: Takeda Pharmaceuticals America I, ed., Deerfield, IL; 2016. Takeda. Dexilant (dexlansoprazole) delayed release capsules. Full prescribing information. In: Takeda Pharmaceuticals America I, ed., Deerfield, IL; 2016.
33.
go back to reference Kukulka M, Wu J, Perez MC. Pharmacokinetics and safety of dexlansoprazole MR in adolescents with symptomatic GERD. J Pediatr Gastroenterol Nutr. 2012;54:41–47.CrossRefPubMed Kukulka M, Wu J, Perez MC. Pharmacokinetics and safety of dexlansoprazole MR in adolescents with symptomatic GERD. J Pediatr Gastroenterol Nutr. 2012;54:41–47.CrossRefPubMed
35.
go back to reference World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194.CrossRef World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194.CrossRef
36.
go back to reference International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use. ICH harmonized tripartite guideline: guideline for good clinical practice. J Postgrad Med. 2001;47:45–50. International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use. ICH harmonized tripartite guideline: guideline for good clinical practice. J Postgrad Med. 2001;47:45–50.
37.
go back to reference Kleinman L, Nelson S, Kothari-Talwar S, et al. Development and psychometric evaluation of 2 age-stratified versions of the Pediatric GERD Symptom and Quality of Life Questionnaire. J Pediatr Gastroenterol Nutr. 2011;52:514–522.CrossRefPubMed Kleinman L, Nelson S, Kothari-Talwar S, et al. Development and psychometric evaluation of 2 age-stratified versions of the Pediatric GERD Symptom and Quality of Life Questionnaire. J Pediatr Gastroenterol Nutr. 2011;52:514–522.CrossRefPubMed
38.
go back to reference Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. (quiz 1943).CrossRefPubMed Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. (quiz 1943).CrossRefPubMed
39.
go back to reference Sherman PM, Hassall E, Fagundes-Neto U, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104:1278–1295. (quiz 1296).CrossRefPubMed Sherman PM, Hassall E, Fagundes-Neto U, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104:1278–1295. (quiz 1296).CrossRefPubMed
40.
go back to reference Brown EG, Wood L, Wood S. The medical dictionary for regulatory activities (MedDRA). Drug Saf. 1999;20:109–117.CrossRefPubMed Brown EG, Wood L, Wood S. The medical dictionary for regulatory activities (MedDRA). Drug Saf. 1999;20:109–117.CrossRefPubMed
41.
go back to reference Pace F, Scarlata P, Casini V, Sarzi-Puttini P, Porro GB. Validation of the reflux disease questionnaire for an Italian population of patients with gastroesophageal reflux disease. Eur J Gastroenterol Hepatol. 2008;20:187–190.CrossRefPubMed Pace F, Scarlata P, Casini V, Sarzi-Puttini P, Porro GB. Validation of the reflux disease questionnaire for an Italian population of patients with gastroesophageal reflux disease. Eur J Gastroenterol Hepatol. 2008;20:187–190.CrossRefPubMed
43.
go back to reference van Pinxteren B, Sigterman KE, Bonis P, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2010:CD002095. van Pinxteren B, Sigterman KE, Bonis P, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2010:CD002095.
44.
go back to reference Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–328. (quiz 329).CrossRefPubMed Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–328. (quiz 329).CrossRefPubMed
45.
go back to reference Vakily M, Zhang W, Wu J, Atkinson SN, Mulford D. Pharmacokinetics and pharmacodynamics of a known active PPI with a novel dual delayed release technology, dexlansoprazole MR: a combined analysis of randomized controlled clinical trials. Curr Med Res Opin. 2009;25:627–638.CrossRefPubMed Vakily M, Zhang W, Wu J, Atkinson SN, Mulford D. Pharmacokinetics and pharmacodynamics of a known active PPI with a novel dual delayed release technology, dexlansoprazole MR: a combined analysis of randomized controlled clinical trials. Curr Med Res Opin. 2009;25:627–638.CrossRefPubMed
46.
go back to reference Kukulka M, Eisenberg C, Nudurupati S. Comparator pH study to evaluate the single-dose pharmacodynamics of dual delayed-release dexlansoprazole 60 mg and delayed-release esomeprazole 40 mg. Clin Exp Gastroenterol. 2011;4:213–220.CrossRefPubMedPubMedCentral Kukulka M, Eisenberg C, Nudurupati S. Comparator pH study to evaluate the single-dose pharmacodynamics of dual delayed-release dexlansoprazole 60 mg and delayed-release esomeprazole 40 mg. Clin Exp Gastroenterol. 2011;4:213–220.CrossRefPubMedPubMedCentral
47.
go back to reference Fass R, Chey WD, Zakko SF, et al. Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease. Aliment Pharmacol Ther. 2009;29:1261–1272.CrossRefPubMed Fass R, Chey WD, Zakko SF, et al. Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease. Aliment Pharmacol Ther. 2009;29:1261–1272.CrossRefPubMed
48.
49.
Metadata
Title
Dexlansoprazole for Heartburn Relief in Adolescents with Symptomatic, Nonerosive Gastro-esophageal Reflux Disease
Authors
Benjamin D. Gold
Betsy Pilmer
Jaroslaw Kierkuś
Barbara Hunt
Maria Claudia Perez
David Gremse
Publication date
01-11-2017
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 11/2017
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-017-4743-3

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