title: Randomised clinical trial: rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel for the healing of aspirin-related peptic ulcer.
abstract: BACKGROUND
  Clopidogrel does not inhibit prostaglandin synthesis. As a result, clopidogrel's incidence of peptic ulcer disease (PUD) and ulcer bleeding is lower than aspirin's.
  
  
  OBJECTIVE
  To compare the healing rate in aspirin-related dyspeptic ulcer patients who were given proton pump inhibitor (PPI) plus aspirin or PPI plus clopidogrel.
  
  
  METHODS
  Patients with aspirin-related nonbleeding symptomatic ulcers were randomised to receive rabeprazole (20 mg/day) plus aspirin (100 mg/day) or rabeprazole (20 mg/day) plus clopidogrel (75 mg/day) for 12 weeks. The primary endpoint was the successful treatment of PUD as characterised by intention-to-treat at the end of therapy.
  
  
  RESULTS
  Two hundred and eighteen patients (109 in the aspirin group and 109 in the clopidogrel group) were enrolled. There were no statistical demographic differences between the group that received aspirin and the group that received clopidogrel. The PUD treatment success rate was also statistically equal between the clopidogrel and aspirin groups (86.2% vs. 90.0%, P = 0.531). Neither group experienced ulcer-related bleeding. Multivariate logistic regression analysis showed that large ulcer size (>10 mm) (OR: 6.29, 95% CI: 2.58-15.37) and past history of PUD (OR: 3.69, 95% CI: 1.24-10.97) were important predictors of unsuccessful therapy for aspirin-related PUD.
  
  
  CONCLUSIONS
  Rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel in treating aspirin-related symptomatic PUD. Large ulcer size (>10 mm) and past history of PUD are important predictors of unsuccessful therapy (NCT 01037491).
authors: Division of Gastroenterology, Taipei Veterans General Hospital, Taiwan. jcluo@vghtpe.gov.tw
authors: J-C
authors: JC
authors: Luo
authors: K-W
authors: KW
authors: Huang
authors: H-B
authors: HB
authors: Leu
authors: L-C
authors: LC
authors: Chen
authors: M-C
authors: MC
authors: Hou
authors: C-P
authors: CP
authors: Li
authors: C-L
authors: CL
authors: Lu
authors: H-C
authors: HC
authors: Lin
authors: F-Y
authors: FY
authors: Lee
authors: S-D
authors: SD
authors: Lee
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced / Q000188:drug therapy*; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D064750:Rabeprazole; D012044:Regression Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D010975:Platelet Aggregation Inhibitors; D064750:Rabeprazole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin