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Esomeprazole/ASA

Phase 3

Chest Pain | Small molecule | Cardiovascular |AstraZeneca PLC|Last Updated: May 1, 2025

Target and mechanism

ModalitySmall molecule

Also known as Esomeprazole, esomeprazole, Esomeprazole (D961H), Esomeprazole (Nexium), Esomeprazole IV, Double Blind Esomeprazole

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindUNCONTROLLED
Total Trials1
Total Enrollment600

FDA Designations

No designations recorded

Clinical trial landscape

Esomeprazole/ASA · 41 trials · 31 indications

Phase 3 31Phase 2 2Phase 1 8
NCT02157376Stress Ulcer Prophylaxis of Intravenous Esomeprazole in Chinese Seriously Ill PatientsStress Ulcer Prophylaxis
COMPLETED343 Analytics
NCT01370538Efficacy of Esomeprazole in Patients With Frequent HeartburnHeartburn
COMPLETED341 Analytics
NCT01370525Efficacy of Esomeprazole in Patients With Frequent HeartburnHeartburn
COMPLETED340 Analytics
NCT01069939Comparative Efficacy & Safety Study of D961H Versus Placebo for the Prevention of Gastric and Duodenal Ulcers With Low-dose AspirinPrevention
COMPLETED427 Analytics
NCT00634114Reflux Esophagitis Phase III Study (Maintenance Treatment)Reflux Esophagitis
COMPLETED540 Analytics
NCT00633932Reflux Esophagitis Phase III Study (Initial Treatment)Reflux Esophagitis
COMPLETED602 Analytics
NCT00595517Long Term Study to Investigate the Efficacy & Safety of D961H (Esomeprazole) for the Prevention of NSAIDs-induced UlcerGastric Ulcer
COMPLETED395 Analytics
NCT00542789Comparative Efficacy & Safety Study of Esomeprazole Versus Placebo for the Prevention of Gastric and Duodenal Ulcers With NSAIDGastric Ulcer
COMPLETED343 Analytics
NCT00441727Study of Esomeprazole 20 mg or 40 mg vs Placebo Effectiveness on the Occurrence of Peptic Ulcers in Subjects on Low Dose Acetylsalicylic Acid (LDA)Gastric Ulcer
COMPLETED2,426 Analytics
NCT00427635Efficacy and Safety of Esomeprazole Once Daily for the Treatment of GERD in Neonatal PatientsGERD
COMPLETED32 Analytics
PHASE3COMPLETED
Stress Ulcer Prophylaxis of Intravenous Esomeprazole in Chinese Seriously Ill Patients
Stress Ulcer ProphylaxisUnlock trial analytics
PHASE3COMPLETED
Efficacy of Esomeprazole in Patients With Frequent Heartburn
HeartburnUnlock trial analytics
PHASE3COMPLETED
Efficacy of Esomeprazole in Patients With Frequent Heartburn
HeartburnUnlock trial analytics
PHASE3COMPLETED
Comparative Efficacy & Safety Study of D961H Versus Placebo for the Prevention of Gastric and Duodenal Ulcers With Low-dose Aspirin
PreventionUnlock trial analytics
PHASE3COMPLETED
Reflux Esophagitis Phase III Study (Maintenance Treatment)
Reflux EsophagitisUnlock trial analytics
PHASE3COMPLETED
Reflux Esophagitis Phase III Study (Initial Treatment)
Reflux EsophagitisUnlock trial analytics
PHASE3COMPLETED
Long Term Study to Investigate the Efficacy & Safety of D961H (Esomeprazole) for the Prevention of NSAIDs-induced Ulcer
Gastric UlcerUnlock trial analytics
PHASE3COMPLETED
Comparative Efficacy & Safety Study of Esomeprazole Versus Placebo for the Prevention of Gastric and Duodenal Ulcers With NSAID
Gastric UlcerUnlock trial analytics
PHASE3COMPLETED
Study of Esomeprazole 20 mg or 40 mg vs Placebo Effectiveness on the Occurrence of Peptic Ulcers in Subjects on Low Dose Acetylsalicylic Acid (LDA)
Gastric UlcerUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety of Esomeprazole Once Daily for the Treatment of GERD in Neonatal Patients
GERDUnlock trial analytics

Study Endpoints

Primary Endpoints

The Percent of Patients With Clinically Significant Upper-GI Bleeding During the Treatment Evaluation Phase
1-14 days

Criteria for a clinically significant upper GI bleeding as: 1. Bright red blood per NG or OG tube that did not clear after NG or OG tube adjustment and 5 to 10 minutes of at least 100 ml lavage with room temperature normal saline-or, 2. Persistent gastroccult- positive coffee ground material During IMP treatment Day 1-2: Persistent gastroccult- positive coffee ground material for at least eight consecutive hours that did not clear with at least 100 ml of lavage with room temperature normal saline. During IMP treatment Day 3-14: Persistent gastroccult- positive coffee ground material in at least three consecutive gastric aspirates within 2 to 4 hours (at least 60 ±20 minutes apart), that did not clear with at least 100 ml of lavage with room temperature normal saline.

Percentage of Heartburn Free 24 Hour Days During 14 Days of Randomized Treatment
From randomisation to day 14
Time From Randomization to Occurrence of Gastric and/or Duodenal Ulcers up to Data Cut-off Date for Interim Analysis.
From randomisation to up to 48 weeks (Maximum follow-up period at the interim analysis)

Assessments for occurrence of gastric and/or duodenal ulcers were performed every 12 weeks after randomisation. The numbers of participants with recurrence of gastric and/or duodeal ulcers were analysed every 12 weeks up to 48 weeks.

Absence of Recurrence of Reflux Esophagitis According to Los Angeles Classification Throughout the Treatment Period.
Up to 24 weeks

Los Angels classification consists of 5 grades (Grade O, Grade A, Grade B, Grade C and Grade D). A patient classfied into Grade O was considered no reflux esophagitis. The participants who had a healing of reflux esophagitis with Grade O at Visit 1 were randomised. Number of participants who did not have Grades A-D throughout the treatment period was evaluated.

Number of Participants With Healing of Reflux Esophagitis (RE) Who Were Graded "O" at Week 8 Out of Patients Who Were Graded "A, B, C or D" at Baseline According to Los Angeles Classification".
8 weeks

Los Angeles classification consists of 5 grades (Grade O, Grade A, Grade B, Grade C, Grade D). The subjects who were definitely diagnosed to have RE classified into LA classification Grade A, B, C or D based on the EGD on Visit 1 were randomised. A subject classified into LA classification Grade O was considered no reflux esophagitis. The definitions of each grade are: Grade A (Mucosal break \< 5 mm in length), Grade B (Mucosal break \> 5mm), Grade C (Mucosal break continuous between \> 2 mucosal folds) and Grade D (Mucosal break \>75% of esophageal circumference).

Number of Participants Without Gastric and/or Duodenal Ulcer Throughout the Treatment Period
up to 52 weeks
Absence of Gastric and/or Duodenal Ulcer Throughout the Treatment Period
each visit up to 24 weeks

The absence of gastric and/or duodenal ulcer throughout the treatment period

Percentage of Participants Who Experienced the Occurence of Peptic Ulcer(s).
During 26 weeks

The occurrence of ulcer (mucosal break measuring \>= 3 mm over its largest diameter with a sharply demarcated margin) was determined by endoscopy performed at baseline, 8 weeks and 26 weeks or upon withdrawal.

Change From Baseline in Normalized Number of GERD Events Observed From Video and Cardiorespiratory Monitoring
Baseline and end of treatment (10-14 days)

The number of events are normalized prior to summary to correspond to a complete 8-hour monitoring period. Only patients with data at both baseline and final assessment are included.

Evaluate the efficacy by assessment of proportion of subjects who present with no clinically significant bleeding after 5 days treatment
The Percentage of Subjects Whose Gastric Ulcer(s) (GUs) Was (Were) Healed at Week 4 After Treatment With Esomeprazole 20 mg qd and Ranitidine 150 mg Bid in Patients Receiving Daily Non-steroidal Anti-inflammatory Drug (NSAID)Therapy.
4 weeks

Healed was defined as the absence of gastric ulcers. It was calculated as the proportion of subjects whose gastric ulcer(s) healed after 4 weeks treatment. (Ulcers were on S stage, stage 1 = Nonblanchable erythema of intact skin, stage 2 = Partial thickness skin loss involving epidermis, dermis, or both, stage 3 = Full thickness skin loss involving damage to or necrosis of subcutaneous tissue, stage 4 = Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures or absent).

Clinically Significant Rebleeding Within 72 Hours of Continous Infusion of Esomeprazole or Placebo
Within 72 hours
Change from baseline after 6 months in the level of ki-67 expression and histological markers of esophageal epithelial acid-related disease after acid-suppressive therapy with esomeprazole
First Event of Death, Oesophageal Adenocarcinoma, High Grade Dysplasia
Events are assessed from the date of randomisation to the end of study which can be patient withdrawal, loss to follow up or study end (8 years or 10 years from randomisation, depending on consent)

Death is recorded on a continuous basis through reporting from trial sites. Oesophageal adenocarcinoma is recorded through endoscopies taken every two years or ad-hoc at clinician decision High Grade Dysplasia is recorded through endoscopies taken every two years or ad-hoc at clinician decision

The primary variable is presence of gastric and/or duodenal ulcers at endoscopy over a 26-week period in patients taking low-dose ASA.
Relief of pain or discomfort in the chest during the last week of the 4-week treatment course.
Relief of pain or discomfort in the chest is defined as no more than one day with minimal symptoms according to the patients assessment
To evaluate safety & how tolerable a once daily treatment with esomeprazole is in pediatric & adolescent patients
12 to 17 years of age, inclusive, with clinically diagnosed Gastroesophageal Reflux Disease (G
To demonstrate a difference between esomeprazole 20 mg once daily and placebo qd in the resolution and relief of upper abdominal pain after 4 weeks of treatment in patients with sGERD
Daily diary cards completed by the patient
The primary outcome is whether the patient is a responder or not after 8 weeks treatment.
The primary efficacy outcome is based on symptom score recorded daily during the study in a patient diary.
The patient will judge their symptoms of pain or burning centered in the upper abdomen on a four-graded scale (none, mild, moderate or severe).
Number of Participants With Treatment Failure at 5 Years
During 5 years

Treatment failure in the surgical arm defined when need for medical treatment for control of symptoms from reflux disease. Treatment failure in the medical arm defined when need for treatment other than esomeprazole for control of symptoms of reflux disease.

Difference between the proportion of patients who discontinued on-demand esomeprazole treatment versus continuous esomeprazole treatment due to unsatisfactory treatment as determined by the investigator in consultation with the patient
6 months

Compare on demand (taken as needed by the patient to adequately control their reflux disease) with continuous treatment of endoscopy negative subjects with gastroesophageal reflux disease (GERD), with esomeprazole 20-mg once daily, with regards to willingness to continue in the study as a result of satisfactory treatment over a six-month long term management period, after initial symptom relief

To assess the efficacy of esomeprazole versus placebo through 6 months of treatment for the prevention of relapse of upper GI symptom associated with NSAID use
To assess the efficacy of esomeprazole 40 mg qd versus placebo and esomeprazole 20 mg qd versus placebo for up to 6 months of the treatment for the prevention of gastric (and/or duodenal) ulcers in patients receiving daily NSAID therapy and being at risk
Assessments at Week 0, Week 4, Week 12, Week 26
To assess the safety and efficacy of esomeprazole 40 mg qd versus ranitidine 150 mg bid through 8 weeks of treatment for the healing of gastric ulcers in patients receiving daily NSAID therapy. Healing is defined as the absence of gastric ulcers.
The proportion of patients with no gastric ulcers after 8 weeks of treatment.
Esophagogastroduodenscopy (EGD) assessments at baseline, week 4, week 8, and efficacy evaluations at each visit including endoscopic evaluation for the presence of ulcers and erosions.
To assess the efficacy of esomeprazole 40 mg qd versus placebo and esomeprazole 20 mg qd versus placebo for up to 6 months of treatment for the prevention of gastric (and duodenal) ulcers in patients receiving daily NSAID therapy.
Assessments at Week 0, Week 4, Week 12, Week 26
To assess the efficacy of esomeprazole 40 mg orally q.d. versus placebo orally q.d.
and 20 mg q.d. versus placebo orally q.d. through 6 months of treatment for the
prevention of relapse of upper GI symptom associated with NSAID use in patients
receiving daily NSAID therapy.
To assess the efficacy of esomeprazole versus placebo through 4 weeks of treatment of upper GI symptoms associated with nonsteroidal anti-inflammation
Mean change in the upper GI symptoms (pain, discomfort or
burning in the upper abdomen), rated on a 7-graded severity scale
Mean Change in Morning Peak Expiratory Flow (mPEF (L/Minute)) From Baseline (Mean of the Last 7 Days in the run-in Period) to Treatment Period (Mean of All Available Data During the Treatment Period).
Baseline to 6 months

Peak expiratory flow is defined as the maximum speed of expiration as measured with the Mini-Wright® PEF Meter. Participants must have both baseline and follow up measure to be included in analysis. Results presented as a mean of all available data during the treatment period.

Effect on asthma symptoms as measured by changes in Peak Expiratory Flow morning & evening, Forced Expiratory Volume and asthma symptom scores
4 weekly
Observed maximum concentration (Cmax)
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
time of maximum concentration (tmax)
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
area under the concentration-time curve from zero to time of last quantifiable concentration (AUC(0-t))
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
area under the concentration-time curve from zero to infinity (AUC)
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
apparent terminal rate constant (λz), apparent terminal half-life (t1/2)
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
apparent systemic clearance after extravascular dosing (CL/F)
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
apparent volume of distribution following extravascular dosing (Vz/F) for naproxen and esomeprazole
Pharmacokinetic samples will be collected at pre-dose, 10, 20, 30, and 45 minutes post-dose, and 1, 1.5, 2,2.5, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours post-dose. The 72 hour post-dose sample will be collected at Visit 3 (Follow-up).
The effect of esomeprazole 20 mg/ acetylsalicylic acid 81 mg on the pharmacodynamics of clopidogrel by assessing maximal inhibition of platelet aggregation after 9 days of clopidogrel treatment relative to baseline
Pharmacodynamic sampling will be done before treatment period 1.
Evaluate the effect of esomeprazole on low-dose aspirin pharmacodynamics by assessing the relative change in the VerifyNow Aspirin test after 5 days of treatment, relative to baseline (Day 1) in healthy human volunteers
Ongoing throughout the study from consent through withdrawal
To investigate the effects of food on the extent and rate of absorption of ASA and esomeprazole after a single dose administration of esomeprazole 20mg/ASA 81 mg FDC in healthy volunteers by assessment of AUC, AUC(0-t), and Cmax
Blood samples for ASA and SA analyses will be taken at predose, 0.25, 0.5, 0.75, 1, 1.25, 1.5, 1.75, 2, 2.25, 2.5, 3, 4, 5, 6, 8, 10, 12, and 14 hours after dose administration
Plasma concentration-time curve from time 0 to the last quantifiable concentration for esomeprazole administered as fixed dose combination (FDC) to esomeprazole administered as free combinations
PK samples to be taken for bioanalysis over a 24-hour period following dosing on Day 1 of Period I and Day 1 of Period II and III.
Samples for measurement of esomeprazole, ASA, and SA concentrations
Day 1 of each period
pharmacokinetic profile of D961H during repeated administration with and without co-administration of loxoprofen and pharmacokinetic profile of loxoprofen during repeated administration with and without co-administration of D961H, assessing plasma conc.
5-7 days after the last dose of study medication is given
Pharmacokinetic-area under plasma concentration versus time curve within a dosing interval
Day 4 of study

Secondary Endpoints

Proportion of Patients With Any Overt Upper-GI Bleeding (Significant and Non-significant) During the Treatment Evaluation Phase
1-14 days
Number of Subjects Reporting Heartburn 2 Days or Less During the 14 Days Randomized Treatment Period
From randomisation to the day 14
Comparison of Number of Subjects With 0, 1, 2, 3 or 4 Days With no Heartburn Over Days 1 to 4 Between Esomeprazole 20 mg and Placebo
From randomisation to day 14
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Study Design & Arms

AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposePREVENTION

Treatment Arms

ArmTypeDescription
Esomeprazole active treatmentEXPERIMENTALiv esomeprazole 30 min intermittent infusions given for maximum 14 days
Cimetidine active treatmentACTIVE_COMPARATORiv cimetidine 30 min bolus infusion followed by iv cimetidine continuous infusion given for maximum 14 days
Esomeprazole 20 mgEXPERIMENTAL -
PlaceboPLACEBO_COMPARATOR -
Esomeprazole 20mgEXPERIMENTALEsomeprazole 20mg once daily oral
1EXPERIMENTALEsomeprazole and Omeprazole
2EXPERIMENTALEsomeprazole
3ACTIVE_COMPARATOROmeprazole 20mg
Esomeprazole 40 mgEXPERIMENTALEsomeprazole 40 mg
Arm AEXPERIMENTAL20mg Esomeprazole
Arm BEXPERIMENTAL80mg Esomeprazole
Arm CEXPERIMENTAL20mg Esomeprazole + 300mg Aspirin
Arm DEXPERIMENTAL80mg Esomeprazole + 300mg Aspirin
On demand 20 mg esomeprazoleEXPERIMENTALOn demand treatment with 20-mg esomeprazole once daily when needed
Continuous 20 mg esomeprazoleACTIVE_COMPARATORContinuous treatment with 20 mg esomeprazole once daily
Esomeprazole 40 mg twice dailyEXPERIMENTAL -
Esomeprazole 40 mg once dailyEXPERIMENTAL -

Interventions

NameTypeDescription
EsomeprazoleDRUGiv esomeprazole 30 min intermittent infusions given for maximum 14 days
CimetidineDRUGiv cimetidine 30 min bolus infusion followed by iv cimetidine continuous infusion given for maximum 14 days
PlaceboDRUGPlacebo, capsule, 72 weeks
OmeprazoleDRUG10mg once daily oral administration
Esomeprazole 20 mgDRUGEsomeprazole 20 mg once daily
Esomeprazole 40 mgDRUGEsomeprazole 40 mg once daily
Esomeprazole IVDRUG -
Omeprazole IVDRUG -
RanitidineDRUG -
AspirinDRUG300mg per day
Esomeprazole (Nexium)DRUG -
Matching placeboDRUGOral Once Daily
Laparoscopic fundoplication (surgery)PROCEDURESurgery
naproxenDRUG250mg, oral dose
ClopidogrelDRUGClopidogrel
Esomeprazole/ASADRUG20 mg/81 mg once daily for five days (Day 5-9)
esomeprazole/ASA Fixed Dose Combination (FDC)DRUGesomeprazole 20 mg/ASA 81 mg oral capsule
Esomeprazole/ASA Fixed CombinationDRUGCapsule, oral, single dose
Esomeprazole - NexiumDRUGClinical Trial Capsule or MUPS Tablet, oral, single dose
ASADRUGTablet, oral, single dose
Esomeprazole 40mg/ASA 325mgDRUGcombination capsule, administered as a single oral dose
Esomeprazole (D961H)DRUG20mg
LoxoprofenDRUG60mg tablet
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Eligibility Criteria

Age Range18 Years to 70 Years
SexALL
Healthy VolunteersNo
Study Sites15

Inclusion Criteria: 1. Critically ill patients 2. Requirement for mechanical ventilation 3. At least one major risk factor for stress ulcer related bleeding Exclusion Criteria: 1. History of gastric or oesophageal surgery 2. Evidence of active GI bleeding 3. Advanced renal disease 4. Treatment wi...

Countries:ChinaUnited StatesJapanSouth KoreaTaiwanArgentinaAustraliaBulgariaCanadaCzechiaFinlandGermanyIndonesiaMexicoNorwayPhilippinesPolandPortugalRomaniaRussiaSlovakiaSouth AfricaThailandUnited KingdomHong KongAustriaDenmarkFranceGreeceNetherlandsSpainSwedenTurkey (Türkiye)HungaryItalyBelgiumSwitzerlandBrazilIcelandSingapore
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