PREVENTION OF GASTROINTESTINAL COMPLICATIONS ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Nonsteroidal antiinflammatory drugs (NSAID), although used frequently for the treatment of arthritis and musculoskeletal disorders, may prod uce deleterious effects related to the gastrointestinal (GI) tract, in cluding dyspeptic symptoms, erosions, ulcers, and serious GI complicat ions (i.e., bleeding, perforation, and gastric outlet obstruction). En doscopic studies with the synthetic prostaglandin E-1 analog misoprost ol, various acid-reducing agents (e.g., H-2 receptor antagonists and p roton pump inhibitors), and surface-active drugs such as sucralfate, h ave been shown to prevent NSAID induced gastric and/or duodenal ulcers . The Misoprostol Ulcer Complication Outcomes Safety Assessment (MUCOS A) trial was a 6 month, randomized, double blind, placebo controlled s tudy to investigate whether concurrent administration of misoprostol w ould significantly reduce the occurrence of serious upper GI complicat ions in patients with rheumatoid arthritis (RA) who were receiving NSA ID. Results showed that overall complications were reduced by 40% (p = 0.049) among patients receiving misoprostol (25 patients with definit e serious GI events among 4404 patients treated) compared with those r eceiving placebo (42 out of 4439 patients). Thus, cotherapy with misop rostol resulted in a statistically significant reduction in the incide nce of serious NSAID induced upper GI complications compared with plac ebo in patients with RA.