Is Esomeprazole better than other Proton Pump Inhibitors?

Q: Is Esomeprazole superior to other PPIs like Pantoprazole, Lansoprazole or Rabeprazole? Does it really have better bioavailability, better AUC and better intra-gastric pH control than them?

A:There is hardly any difference in the efficacy and safety profile of various Proton Pump Inhibitors such as omeprazole, lansoprazole, pantoprazole, rabeprazole. In many cases, the reasons for discovering a new molecule are no more than to take advantage of the patent protection and exclusivity which helps in pricing due to monopoly situation. The moment a drugs patent expires, many manufacturers start marketing the same molecule which reduces the price and profits. For example, in Australia there are five brands of omeprazole due to expiry of patent. Esomeprazole is the patented product of AstraZeneca. It is S-isomer of omeprazole. Interestingly Omeprazole was also the patented molecule of the same company which has now expired.Coming to scientific issue, the UK National Institute of Clinical Excellence (NICE) has determined that there are no significant differences between various PPIs.The comparison between various PPIs in combination triple therapy to eradicate H. pylori infection shows that the cure rate with omeprazole (such as Ocid) is up to 96%, pantoprazole (such as Pantodac) also up to 96% while with esomeprazole (such as Sompraz), it is only 90%.