Duodenal and gastric ulcer prevention with misoprostol in arthritis patients taking NSAIDs. Misoprostol Study Group.
OBJECTIVE
To determine the efficacy of misoprostol for the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced duodenal and gastric ulcers in arthritis patients receiving NSAID therapy.


METHODS
A randomized, double-blind, multicenter, placebo-controlled trial.


METHODS
Six hundred thirty-eight private, Veterans Affairs, health maintenance, and academic practices.


METHODS
Six hundred thirty-eight patients with chronic inflammatory or noninflammatory arthritis who were taking an NSAID but who did not have a gastric or duodenal ulcer on screening endoscopy received treatment with ibuprofen, piroxicam, naproxen, sulindac, tolmetin, indomethacin, or diclofenac daily for 3 months. Four hundred fifty-five (71%) patients completed the trial.


METHODS
Patients meeting the entry criteria were randomized to receive either misoprostol, 200 micrograms, or placebo, four times a day for 12 weeks.


METHODS
The endoscopy was repeated at 4, 8, and 12 weeks. The development of a duodenal or gastric ulcer (defined as a circumscribed mucosal defect > or = 0.5 cm in diameter and with perceptible depth) was regarded as prophylactic failure.


RESULTS
By 12 weeks, a duodenal ulcer developed in 2 of 320 (0.6%; 95% CI, 0.2% to 3.9%) patients randomized to receive misoprostol, compared with 15 of 323 (4.6%; CI, 2.8% to 8%) patients receiving placebo (P = 0.002). A gastric ulcer developed in 6 of 320 (1.9%; (CI, 0.8% to 4.4%) patients, compared with in 25 of 323 (7.7%; CI, 5.1% to 11.4%), respectively.


CONCLUSIONS
Misoprostol significantly lowers the frequency of both duodenal and gastric ulcer development in patients who require long-term therapy with NSAIDS.
Graham
D Y
DY
Veterans Affairs Medical Center/Baylor College of Medicine, Houston, Texas.
White
R H
RH
Moreland
L W
LW
Schubert
T T
TT
Katz
R
R
Jaszewski
R
R
Tindall
E
E
Triadafilopoulos
G
G
Stromatt
S C
SC
Teoh
L S
LS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001168:Arthritis / Q000188:drug therapy*; D004311:Double-Blind Method; D004381:Duodenal Ulcer / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000627:therapeutic use*; D013276:Stomach Ulcer / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016595:Misoprostol