Misoprostol coadministered with diclofenac for prevention of gastroduodenal ulcers. A one-year study.
The objective of this study was to determine the long-term efficacy of misoprostol in preventing diclofenac-induced gastroduodenal ulcers in rheumatoid arthritis and osteoarthritis patients. Three hundred eighty-four patients who had an endoscopically confirmed gastric or duodenal lesion that had healed with misoprostol therapy were randomized to receive misoprostol or placebo coadministered with diclofenac for up to 52 weeks. Endoscopic examinations were repeated at weeks 12, 24, and 52. The development of a gastric and/or duodenal ulcer was considered a prophylaxis failure. Results in the evaluable cohort of patients demonstrated that gastroduodenal ulcer incidences were lower with misoprostol than placebo for all study periods (0-12 weeks, 7% vs 23%; 0-24 weeks, 11% vs 26%; and 0-52 weeks, 15% vs 31%). Misoprostol did not interfere with the antiarthritic effects of diclofenac. In conclusion, misoprostol coadministered with diclofenac for 12 months to patients with rheumatoid arthritis or osteoarthritis significantly reduced the incidence of diclofenac-induced gastroduodenal ulcers (P < or = 0.018).
Agrawal
N M
NM
Department of Gastroenterology, Ochsner Clinic, New Orleans, Louisiana 70121, USA.
Van Kerckhove
H E
HE
Erhardt
L J
LJ
Geis
G S
GS
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D015994:Incidence; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D010003:Osteoarthritis / Q000188:drug therapy*; D010437:Peptic Ulcer / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors
D016595:Misoprostol; D004008:Diclofenac