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Amidon PB, Jankovich R, Stoukides CA, Kaul AF. Proton pump inhibitor therapy: Preliminary results of a therapeutic interchange program. American Journal of Managed Care 2000;6: 593-601 Objective: To analyze the experience of one Department of Veterans Affairs hospital in treating with lanzoprazole all patients with acid-peptic disease requiring proton pump inhibitor therapy, including newly diagnosed patents and those who were previously stabilized on omeprazole. Study Design: Retrospective analysis Patients & Methods: We evaluated the chats of 78 patients seen between March 17, 1997, and November 1999 by the Gastroenterology Section at the Togus Veterans Administration Hospital who were diagnosed with acid-peptic disease. Results: Overall, side effects necessitated discontinuation of therapy in 10 (13%) of the lansoprazole-treated patients and non of the omeprazole-treated patients. Nine patients of lansoprazole suffered from persistent diarrhea and were placed on omeprazole, and one had a lower back pain and was switched to cimetidine therapy. Additionally, 12 patients (15%) had their lansoprazole therapy discontinued because of lack of efficacy. Of the 78 lanzoprazole-treated patients, 22 (28%) failed to respond to treatment. Conclusions: Although this study represents preliminary findings and the statistics are observational in nature, important lessons can be learned. At this particular institution the potential 12% savings from mandated therapeutic interchange program were quickly offset by the overall lansoprazole-associated failure rate of 28%. The reproducibility of these preliminary results from an omeprazole-to-lanzoprazone therapeutic interchange program in another institution is unknown but warrants further consideration and additional studies, including those evaluating cost efficacy.
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