H2-receptor antagonists and duodenal ulcer recurrence: analysis of efficacy and commentary on safety, costs, and patient selection.

Maintenance treatment to prevent duodenal ulcer recurrence has been studied in more than 100 trials. These trials, together with reports of long-term safety of maintenance therapy, risk factors of ulcer recurrence, and economic implications of different strategies of long-term ulcer management have been analyzed. Recurrence rates with the FDA-approved drugs for maintenance therapy, cimetidine, ranitidine, and famotidine are comparable when compared as "weighted" or "unweighted" means. H2-blockers reduce the annual recurrence from nearly 70% to about 25%. The duration of maintenance treatment is uncertain, but probably should not be less than 1 yr. Cimetidine maintenance for up to 5 yr has not disclosed new side effects, and the rate of reactions decreases after the first yr. Maintenance is economically superior to intermittent treatment or surgery in the ulcer population, but long-term management should be individualized according to risk factors for recurrence.