NEWER, SAFER NONSTEROIDAL ANTIINFLAMMATORY DRUGS - RATIONAL NSAID SELECTION FOR ARTHRITIS

OBJECTIVE To summarize current evidence that three new additions to no nsteroidal anti-inflammatory drugs (NSAIDs) offer comparable efficacy with fewer adverse effects than established NSAIDs. QUALITY OF EVIDENC E No large random:zed controlled trials (RCTs) have compared all impor tant NSAIDs. Several RCTs have shown that H-2 antagonists do not prote ct against NSAID side effects, but some RCTs compared the protective e ffect of misoprostol (Cytotec) used with other NSAIDs; others have com pared etodolac (Ultradol) or nabumetone (Relafen) with placebo and nap roxen leg, Naprosyn). Postmarketing surveys have been used to support claims that the new NSAIDs have few gastric or renal side effects. MAI N FINDINGS Using misoprostol in conjunction with traditional NSAIDs re duces gastric and renal adverse effects. Misoprostol can be taken at t he same time as NSAIDs or in a combination tablet. Two new NSAIDS, eto dolac and nabumetone, do not inhibit cyclooxygenase 1 prostaglandins, which occur in the stomach and kidneys, but more selectively block cyc looxygenase 2 prostaglandins, which cause arthritic inflammation. Thes e two NSAIDs have efficacy profiles comparable to older NSAIDs but hav e markedly fewer side effects. CONCLUSIONS Safer treatment for arthrit is can be achieved by combining misoprostol with traditional NSAIDs or by using one of two new agents, nabumetone or etodolac.