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Cytoprotective agent for peptic ulcer prevention in patients taking dual antiplatelet agents: A randomized, double-blind placebo-controlled trial

Rapat Pittayanon, Panida Piyachaturawat, Rungsun Rerknimitr, Piyapan Prueksapanich, Supakarn Chaitongrat, Vorarit Lertsuwunseri, Suphot Srimahachota, Varocha Mahachai
Journal of Gastroenterology and Hepatology 2019 March 28

BACKGROUND: Long-term use of dual antiplatelets is increasing, and most patients need primary peptic ulcer prophylaxis. The long-term use of proton pump inhibitors (PPIs) is associated with adverse events. We evaluated the efficacy of rebamipide for peptic ulcer prevention.

METHODS: This RCT was conducted between July 2014 and November 2017. Patients receiving dual antiplatelets for ≥1 year with no history of peptic ulcer bleeding or perforation were recruited and randomly assigned to the rebamipide (300 mg/day) group or the placebo group. Patients who used PPIs were excluded. The primary endpoint was a new mucosal break on EGD at 3 or 12 months after treatment initiation. The secondary endpoints were haematocrit (Hct) changes from the baseline, GI bleeding, and chest pain. Antiplatelet function was assessed.

RESULTS: In total, 95 eligible patients were identified; twelve were excluded, and 83 patients were randomized, with 66 (79.5%) and 59 (71.1%) patients eligible at the 3- and 12-month follow-ups, respectively. The baseline characteristics were equivalent between the groups. During the 12 months of follow-up, 13 patients (43.3%) taking rebamipide and 19 (65.5%) taking the placebo experienced mucosal injury (p=0.07). Two patients (6.7%) taking rebamipide and 8 (27.6%) taking the placebo had peptic ulcers ≥5 mm or <5 mm with pigmented spots (p=0.03). The changes in Hct were not different between the two groups. Neither bleeding ulcers nor chest pain was observed.

CONCLUSION: Rebamipide is safe and may prevent peptic ulcers ≥ 5 mm in diameter or those with pigmented spots in patients receiving dual antiplatelets for one year (NCT02166008).


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