Active Duodenal Ulcer In a multicenter, double-blind, controlled, US study of endoscopically diagnosed duodenal ulcers, earlier healing was seen in the patients treated with ranitidine as shown in Table 3.
Table 3. Duodenal Ulcer Patient Healing Rates
| | Ranitidine1 | Placebo1 |
| | Number Entered | Healed/ Evaluable | NumberEntered | Healed/ Evaluable |
| Outpatients Week 2 | 195 | 69/182 (38%) 2 | 188 | 31/164 (19%) |
| Week 4 | 137/187 (73%)2 | 76/168 (45%) |
1.All patients were permitted antacids as needed for relief of pain.
2. P< 0.0001.
In these studies patients treated with ranitidine reported a reduction in both daytime and nocturnal pain, and they also consumed less antacid than the placebo-treated patients.
Table 4. Mean Daily Doses of Antacid
| | Ulcer Healed | Ulcer Not Healed |
Ranitidine Placebo | 0.06 0.71 | 0.71 1.43 |
Foreign studies have shown that patients heal equally well with 150 mg two times a day and 300 mg at bedtime (85% versus 84%, respectively) during a usual 4-week course of therapy. Ifpatients require extended therapy of 8 weeks, the healing rate may be higher for 150 mg two times a day as compared to 300 mg at bedtime (92% versus 87%, respectively). Studies have been limited to short-term treatment of acute duodenal ulcer. Patients whose ulcers healed during therapy had recurrences of ulcers at the usual rates.
Maintenance Therapy in Duodenal Ulcer Ranitidine has been found to be effective as maintenance therapy for patients following healing of acute duodenal ulcers. In two independent, double-blind, multicenter, controlled trials, the number of duodenal ulcers observed was significantly less in patients treated with ranitidine (150 mg at bedtime) than in patients treated with placebo over a 12-month period.
Table 5. Duodenal Ulcer Prevalence
| Double–blind, Multicenter, Placebo-Controlled Trials |
| Multicenter Trial | Drug | Duodenal Ulcer Prevalence | |
| | | 0 to 4Months | 0 to 8Months | 0 to 12Months | No. of Patients |
| USA | RAN1 | 20%23 | 24%23 | 35%23 | 138 |
| | PLC4 | 44%2 | 54%2 | 59%2 | 139 |
| Foreign | RAN1 | 12%23 | 21%23 | 28%23 | 174 |
| | PLC4 | 56%2 | 64%2 | 68%2 | 165 |
1. RAN = ranitidine.
2. % = Life Table estimate.
3. P<0.05 (Ranitidine versus comparator).
4. PLC = placebo.
As with other H2-antagonists, the factors responsible for the significant reduction in the prevalence of duodenal ulcers include prevention of recurrence of ulcers, more rapid healing of ulcers that may occur during maintenance therapy, or both.
Gastric Ulcer: In a multicenter, double-blind, controlled, US study of endoscopically diagnosed gastric ulcers, earlier healing was seen in the patients treated with ranitidine as shown in Table 6.
Table 6. Gastric Ulcer Patient Healing Rates
|
| Ranitidine1 | Placebo1 |
|
| Number Entered | Healed/ Evaluable | Number Entered | Healed/ Evaluable |
| Outpatients Week 2 | 92 | 16/83 (19%) | 94 | 10/83 (12%) |
|
Week 4 |
| 50/73 (68%)2 |
| 35/69 (51%) |
1. All patients were permitted antacids as needed for relief of pain.
2. P=0.009.
In this multicenter trial, significantly more patients treated with ranitidine became pain free during therapy.
Maintenance of Healing of Gastric Ulcers
In two multicenter, double-blind, randomized, placebo-controlled, 12-month trials conducted in patients whose gastric ulcers had been previously healed, ranitidine tablets or ranitidine capsules 150 mg at bedtime were significantly more effective than placebo in maintaining healing of gastric ulcers.
Pathological Hypersecretory Conditions (such as Zollinger-Ellison syndrome)
Ranitidine inhibits gastric acid secretion and reduces occurrence of diarrhea, anorexia, and pain in patients with pathological hypersecretion associated with Zollinger-Ellison syndrome, systemic mastocytosis, and other pathological hypersecretory conditions (e.g., postoperative, “short-gut” syndrome, idiopathic). Use of ranitidine was followed by healing of ulcers in 8 of 19 (42%) patients who were intractable to previous therapy.
Gastroesophageal Reflux Disease (GERD)
In two multicenter, double-blind, placebo-controlled, 6-week trials performed in the United States and Europe, ranitidine 150 mg two times a day was more effective than placebo for the relief of heartburn and other symptoms associated with GERD. Ranitidine-treated patients consumed significantly less antacid than did placebo-treated patients. The US trial indicated that ranitidine 150 mg two times a day significantly reduced the frequency of heartburn attacks and severity of heartburn pain within 1 to 2 weeks after starting therapy. The improvement was maintained throughout the 6-week trial period. Moreover, patient response rates demonstrated that the effect on heartburn extends through both the day and night time periods. In two additional US multicenter, double-blind, placebo-controlled, 2 week trials, ranitidine 150 mg two times a day was shown to provide relief of heartburn pain within 24 hours of initiating therapy and a reduction in the frequency of severity of heartburn.
Erosive Esophagitis
In two multicenter, double-blind, randomized, placebo-controlled, 12-week trials performed in the United States, ranitidine 150 mg 4 times daily was significantly more effective than placebo in healing endoscopically diagnosed erosive esophagitis and in relieving associated heartburn. The erosive esophagitis healing rates were as follows:
Table 7. Erosive Esophagitis Patient Healing Rates
| | Healed/Evaluable |
| | Placebo1n=229 | Ranitidine150 mg 4 times daily1 n=215 |
| Week 4 | 43/198(22%) | 96/206 (47%)2 142/200 (71%)2 |
| Week 8 | 63/176 (36%) |
| Week 12 | 92/159 (58%) | 162/192 (84%)2 |
1. All patients were permitted antacids as needed for relief of pain.
2. P < 0.001 versus placebo.
No additional benefit in healing of esophagitis or in relief of heartburn was seen with a ranitidine dose of 300 mg 4 times daily.
Maintenance of Healing of Erosive Esophagitis
In two multicenter, double-blind, randomized, placebo-controlled, 48-week trials conducted in patients whose erosive esophagitis had been previously healed, ranitidine 150 mg two times a day was significantly more effective than placebo in maintaining healing of erosive esophagitis.