The cytoprotective properties of native
prostaglandins have been exploited for
ulcer therapy through the development of analogous molecules, which are characterized by longer duration of action, more potent
acid inhibitory effect and higher pharmacologic specificity. The therapeutic efficacy of
prostaglandin analogues has been evaluated in a variety of controlled clinical trials, which are summarized briefly. The experience with
arbaprostil,
enprostil,
misoprostol,
rioprostil and
trimoprostil shows that their effect on
ulcer healing is superior to that of a placebo in
acid inhibitory doses, which are also cytoprotective. Nevertheless,
prostaglandin analogues are inferior to H2-receptor antagonists as regards their effects on
ulcer healing,
pain relief, and
relapse prevention and less effective than expected from their
acid inhibitory action. Placebo controlled trials of
arbaprostil in acute upper gastrointestinal haemorrhage have failed to demonstrate any reduction in numbers of patients whose
bleeding stopped, numbers with rebleeding or transfusion requirement. Diarrhoea occurs in 4%-34% of all patients and
prostaglandin analogues are contraindicated in pregnant women. Although these drugs will probably not be marketed in Denmark for
ulcer therapy, they may prove useful as replacement
therapy in patients requiring nonsteroidal antiinflammatory drugs.