LETTER
Misoprostol and Gastrointestinal Complications in Patients Taking Nonsteroidal Anti-Inflammatory Drugs for Rheumatoid Arthritis
Heinz F. Hammer, MD
15 May 1996 | Volume 124 Issue 10 | Page 927
TO THE EDITOR:
Silverstein and colleagues [1] have shown that prophylactic treatment with misoprostol reduces serious gastrointestinal complications in patients receiving NSAIDs but does not save lives. Although the approximately 50% reduction in the number of complications seems impressive at first glance, the clinical relevance of this finding is questionable. The absolute number of complications was reduced by only 17 in a total of more than 4400 treated patients. In addition, of these 4400 patients, more than 1600 had symptoms during NSAID treatment, and another 234 developed symptoms that caused them to withdraw from the study. Thus, dyspeptic symptoms were not satisfactorily addressed by the treatment in 42% of patients in the misoprostol group.
The time has come to direct our attention to treating the frequently occurring symptoms of NSAID intolerance rather than to preventing the rare complications of NSAID-induced ulcers (which are no longer life threatening). I suggest that drugs proven to reduce dyspeptic symptoms, such as antacids [2] or sucralfate [3], be used as first-line therapy in patients who develop gastrointestinal symptoms during NSAID treatment.
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Author and Article Information
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University of Graz; 8036 Graz, Austria
1. Silverstein FE, Graham DY, Senior JR, Wyn Davies H, Struthers BJ, Bittman RM, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995; 123:241-9.
2. Roth SH. Efficacy of antacid therapy for NSAID-induced symptomatic gastropathy. Practical Gastroenterology. 1994; 18:14-20.
3. Caldwell JR, Roth SH, Wu WC, Semble EL, Castell DO, Heller MD, et al. Sucralfate treatment of nonsteroidal anti inflammatory drug-induced gastrointestinal symptoms and mucosal damage. Am J Med. 1987; 83:74-82.
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