title: Preventive therapy for non-steroidal anti-inflammatory drug-induced ulcers in Japanese patients with rheumatoid arthritis: the current situation and a prospective controlled-study of the preventive effects of lansoprazole or famotidine.
abstract: BACKGROUND
  There is a lack of evidence for the efficacy of preventive medications for peptic ulcers (PUs) among long-term users of non-steroidal anti-inflammatory drugs (NSAIDs) in Japan.
  
  
  OBJECTIVE
  To estimate the preventive effect by normal dose, not high-dose histamine-H2 receptor antagonists (H2RA) for NSAID-induced ulcers.
  
  
  METHODS
  We designed two different studies to assess the efficacy of anti-ulcer agents in rheumatoid arthritis (RA) in patients treated over a long term with NSAIDs. An investigative survey divided patients into those not taking anti-ulcer agents (non-medication group); those taking mucosal protective agents (mucosal protectant group), H2RA (H2RA group), proton pump inhibitors (PPI group), or a prostaglandin E1 analog (PG) (PG group). The second study compared prospectively the preventive effects of either famotidine 20 mg bd (famotidine group) or lansoprazole 15 mg daily (lansoprazole group) in patients with PU scars.
  
  
  RESULTS
  The prevalence of PU in the H2RA group was significantly lower compared to the mucosal protectant group (P < 0.05), and the mucosal protectant group was not significantly different to the non-medication group. The prospective study revealed that the PU onset rate of the famotidine group was 8% (1/13), and lansoprazole group was 15% (2/13), indicating no significant differences between the two.
  
  
  CONCLUSIONS
  In Japan, normal-dose H2RA is expected to be a new PU preventive treatment strategy in patients requiring long-term NSAID therapy.
authors.affiliation: Third Department of Internal Medicine, Nippon Medical School, Sendagi, Tokyo, Japan. km366@nms.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Miyake
authors.forename: N
authors.initials: N
authors.lastname: Ueki
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Shinji
authors.forename: M
authors.initials: M
authors.lastname: Kusunoki
authors.forename: T
authors.initials: T
authors.lastname: Hiratsuka
authors.forename: H
authors.initials: H
authors.lastname: Nishigaki
authors.forename: A
authors.initials: A
authors.lastname: Tatsuguchi
authors.forename: S
authors.initials: S
authors.lastname: Futagami
authors.forename: K
authors.initials: K
authors.lastname: Wada
authors.forename: T
authors.initials: T
authors.lastname: Tsukui
authors.forename: A
authors.initials: A
authors.lastname: Nakajima
authors.forename: S
authors.initials: S
authors.lastname: Yoshino
authors.forename: C
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D015738:Famotidine / Q000627:therapeutic use*; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D064747:Lansoprazole; D015738:Famotidine; D009853:Omeprazole