Effectiveness of Changing Drug Classes in Patients With Refractory Laryngopharyngeal Reflux Disease

Emilie Herman; Sven Saussez; Jérôme R Lechien

doi:10.1002/ohn.996

Effectiveness of Changing Drug Classes in Patients With Refractory Laryngopharyngeal Reflux Disease

Otolaryngol Head Neck Surg. 2024 Sep 30. doi: 10.1002/ohn.996. Online ahead of print.

Authors

Emilie Herman¹, Sven Saussez¹, Jérôme R Lechien^{1

2

3

4}

Affiliations

¹ Department of Anatomy, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
² Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research, Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
³ Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.

PMID: 39350512
DOI: 10.1002/ohn.996

Abstract

Objective: To investigate the effectiveness of drug class changes in patients with refractory laryngopharyngeal reflux disease (LPRD).

Study design: Retrospective case series with prospective data.

Setting: Multicenter study.

Methods: The data of patients treated for a refractory LPRD from September 2017 to December 2023 were collected. The effectiveness of drug class changes was assessed through the reflux symptom score (RSS) change. Signs were evaluated with the Reflux Sign Assessment. The RSS reduction was used to categorize the therapeutic responses as mild (20%-40% RSS reduction), moderate (40.1%-60% RSS reduction), high (60.1%-80%), and complete (>80%).

Results: Among the 334 medical records, 74 (22.2%) patients had refractory LPRD defined as no RSS change in the pre- to 3-month posttreatment. The mean age was 52.6 ± 15.5 years. Changing drug class was associated with significant 3- to 6-month posttreatment reductions of RSS and RSA. Thirty patients (39%) did not experience symptom reduction after changing drugs. Changing alginate to magaldrate and magaldrate to alginate was associated with the highest responder rate (76.9%). Changing PPI and alginate/magaldrate molecules led to a response rate of 62.5%. In patients initially treated with a combination of PPI and alginate or magaldrate, changing PPI without changing alginate/magaldrate led to a 37.5% response rate. The baseline RSS was predictive of the 3- and 6-month RSS (therapeutic response).

Conclusion: Changing drug class, especially alginate-to-magaldrate, may be an effective therapeutic approach for patients with a refractory LPRD.

Keywords: change; gastroesophageal; head neck surgery; laryngology; laryngopharyngeal; medication; otolaryngology; reflux; refractory.