Treatment of chronic posterior laryngitis with esomeprazole

Objective. To evaluate the efficacy of acid-suppressive therapy with the proton pump inhibitor esomeprazole on the signs and symptoms of chronic posterior laryngitis (CPL) in patients with suspected reflux laryngitis. Study Design. Prospective, multicenter, randomized, parallel-group trial that compared twice-daily esomeprazole 40 mg with placebo for 16 weeks. Methods: Eligible patients had a history of one or more CPL symptoms (throat clearing, cough, globus, sore throat, or hoarseness) and laryngoscopic signs indicating reflux laryngitis based on CPL index (CPLI) scores measured during a screening laryngoscopy. Patients were randomized to treatment if their 7-day screening diary-card recordings showed a cumulative primary symptom score of 9 or higher and they had 3 or more days with moderately severe symptoms based on a 7-point scale. Efficacy was assessed by changes in symptoms as recorded by patients and investigators and by changes in CPLI scores based on laryngoscopic examinations. Results: The patients' primary CPL symptom at final visit (primary efficacy end point) was resolved in 14.7% (14195) and 16.0% (8/50) of patients in the esomeprazole and placebo groups, respectively (P = .799). Esomeprazole and placebo were not significantly different for change from baseline to the final visit in mean total CPLI (-1.66 +/- 2.13 vs. -2.0 +/- 2.55, respectively; P = .446) or any other secondary efficacy end points based on patient diary card or investigator assessments. Conclusion: This study provides no evidence of a therapeutic benefit of treatment with esomeprazole 40 mg twice daily for 16 weeks compared with placebo for signs and symptoms associated with CPL.