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Misoprostol and Gastrointestinal Complications in Patients Taking Nonsteroidal Anti-Inflammatory Drugs for Rheumatoid Arthritis
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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