Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: NSAID THERAPY AND COPRESCRIPTION OF GPAs Part 2

Prevention of ulcer recurrence

Prevention of ulcer recurrenceMaintenance studies of ulcer healing in patients taking NSAIDs have shown that significantly more patients remain in remission at six months when treated with omeprazole 20 mg or 40 mg daily than when treated with ranitidine 150 mg bid (72% versus 59%, P=0.004) or misoprostol 200 pg qid (61% versus 48%, P=0.001). In the omeprazole- and ranitidine-treated groups, a higher relapse rate was seen for gastric ulcers (5.2% versus 16.3%) than for duodenal ulcers (0.5% versus 4.2%) and erosions (5.7% versus 7.0). For those taking omeprazole, recurrence rates were higher for gastric ulcers than for duodenal ulcers (7.7% versus 2.6%), but for those taking misoprostol, recurrence rates were similar for both ulcer sites (7.8% versus 8.9%), emphasizing the added benefit of acid suppression in patients with duodenal ulcer. Learn how to save money – buy ventolin inhalers to enjoy your shopping and your treatment.

A study comparing lansoprazole 15 mg or 30 mg daily with misoprostol 200 pg qid in patients with a history of gastric ulcer but no active ulcer found no significant difference among the treatment groups at four, eight and 12 weeks, although all treatment groups had a significantly higher healing rate than the placebo groups.

Outcome studies

NSAID users receiving cotherapy with misoprostol have a reduced incidence of endoscopically visible erosions and ulcers. A randomized outcome study of patients with rheumatoid arthritis and no peptic ulcer disease but who were taking NSAIDs found that cotherapy with misoprostol reduced the incidence of serious upper gastrointestinal complications by 40% compared with placebo. While the absolute magnitude of this reduction (0.57% versus 0.95%) was small, the 51% reduction in serious ulcer complications recorded in this study was similar to the reductions in ulcer rates reported in endoscopic studies, suggesting that endoscopic findings may be predictive of the results in NSAIDs outcome studies. However, despite the reduced incidence of NSAID-associated upper gastrointestinal events, the use of misoprostol was complicated by diarrhea, abdominal pain and flatulence, which led to significantly more treatment withdrawals than placebo.

This entry was posted in Coxibs and tagged Coxibs, Cyclooxygenase-2 inhibitors, Gastroprotective agents, Nonsteroidal anti-inflammatory drugs.