title: A randomized, double-blind, placebo-controlled trial of misoprostol for oral mucositis secondary to high-dose chemotherapy.
abstract: OBJECTIVE
  Misoprostol, a synthetic analog of prostaglandin E1, has anti-inflammatory and mucosa-protecting properties. The objective of this study was to evaluate the efficacy of misoprostol oral rinse in reducing the severity of oral mucosal injury caused by high-dose chemotherapy.
  
  
  METHODS
  The study used a randomized, double-blind, placebo-controlled, parallel-group design. Oncology patients receiving myeloablative high-dose chemotherapy, in preparation for a hematopoietic stem cell transplant, were randomized to misoprostol or placebo rinse. The primary outcome measure was the severity of oral mucositis, measured using the modified Oral Mucositis Index. Additional outcome measures included the severity of mouth pain (measured using a Visual Analog Scale and the Pain Affect Faces Scale), duration of hospital stay, and days on total parenteral nutrition.
  
  
  RESULTS
  This study was originally planned to accrue 160 subjects but was terminated early due to revised sponsor research priorities. The intent-to-treat population consisted of 22 subjects randomized to misoprostol rinse and 26 subjects randomized to placebo rinse. There was no significant difference between the two groups in mucositis or pain severity. In both groups, duration of hospital stay was approximately 19 days, and number of days on total parenteral nutrition was 17-18 days. There were no serious adverse events attributable to misoprostol rinse.
  
  
  CONCLUSIONS
  Although this study did not find a beneficial effect of a misoprostol rinse in mucositis secondary to high-dose chemotherapy, the small sample size limits the strength of this conclusion. Given the proposed importance of the prostaglandin pathway in the pathogenesis of oral mucositis, additional studies are warranted.
authors.affiliation: Section of Oral Medicine and Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT, USA. Lalla@nso2.uchc.edu
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
authors.forename: Gary B
authors.initials: GB
authors.lastname: Gordon
authors.forename: Mark
authors.initials: M
authors.lastname: Schubert
authors.forename: Sol
authors.initials: S
authors.lastname: Silverman
authors.forename: Mark
authors.initials: M
authors.lastname: Hutten
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sonis
authors.forename: Francis
authors.initials: F
authors.lastname: LeVeque
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Peterson
mesh_terms: D000704:Analysis of Variance; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016595:Misoprostol / Q000627:therapeutic use*; D010147:Pain Measurement; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D010919:Placebos; D013280:Stomatitis / Q000139:chemically induced* / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000897:Anti-Ulcer Agents; D000970:Antineoplastic Agents; D010919:Placebos; D016595:Misoprostol