There is increasing recognition that nonsteroidal anti-inflammatory drugs (
NSAIDs), while quite effective in treating arthritic symptoms, are associated with gastrointestinal mucosal damage. Although
therapy for patients with
NSAID-induced
ulcers or those at high risk of developing them is still a matter of debate, the current literature supports the use of
misoprostol as the only
drug effective for the prevention of both
NSAID-induced gastric and duodenal ulceration. It has also been shown to treat
NSAID-induced gastropathy in patients continuing their
NSAID therapy. In a study of
misoprostol (100 or 200 micrograms QID) plus
NSAID, after three months of continuous
therapy, a significantly lower frequency of
gastric ulcers in the
misoprostol-treated group was revealed: 100 micrograms
misoprostol, 5.6%; 200 micrograms
misoprostol, 1.4%; placebo, 21.7%. A recent three-month, placebo-controlled study established the efficacy of
misoprostol 200 micrograms QID in the prevention of
NSAID-induced
duodenal ulcers in 429 patients with
osteoarthritis (OA),
rheumatoid arthritis (RA), or other
rheumatic disease, who were receiving daily treatment with various
NSAIDs. The incidence of
duodenal ulcer development over three months was 1.0% in patients treated with
misoprostol versus 6.3% in placebo-treated patients (P = 0.004). The same trial also evaluated the efficacy of
misoprostol 200 micrograms QID versus placebo in preventing
NSAID-induced
gastric ulcers. The incidence of
gastric ulcer over the three-month treatment period was 1.5% in patients treated with
misoprostol versus 9.0% in placebo-treated patients (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)