Long-term, open-label trial: safety and efficacy of continuous maintenance treatment with pantoprazole for up to 15 years in severe acid-peptic disease

Background To date, the safety and tolerability of proton pump inhibitors (PPIs) have been demonstrated in studies of up to 10years. Aim To report on the tolerability, safety and efficacy of up to 15years' continuous treatment with pantoprazole in patients with severe acid-peptic disease. Methods Following healing of endoscopically confirmed peptic ulcer or reflux oesophagitis during 412weeks' treatment with pantoprazole (4080mg/day), adult patients received open-label maintenance treatment with pantoprazole (40160mg/day) for up to 15years in a single centre combined study (10-year initial study; 5-year extension study). Safety assessments were carried out using endoscopy, clinical examination, clinical laboratory investigations, serum gastrin determination, gastric mucosal histology and mucosal endocrine cell quantification. Results The safety set comprised 142 patients. At 12weeks, healing rates were 95.8%. During long-term treatment, mean fasting gastrin levels rose from baseline to moderate levels throughout the study. Mean enterochromaffin-like cell density showed a moderate initial increase during the first 3years, remaining stable thereafter. These changes were not associated with any clinically relevant changes of the gastric mucosa. Patients with successful Helicobacter pylori eradication showed long-term regression of antral and corpus gastritis during continued pantoprazole treatment. Conclusions Daily pantoprazole maintenance therapy for up to 15years for severe acid-peptic disease is effective and well tolerated, with no identified safety concerns. The longest study to date, these data provide reassuring evidence for the long-term safety of pantoprazole.