A CONTROLLED-STUDY COMPARING THE EFFECTS OF NABUMETONE, IBUPROFEN, AND IBUPROFEN PLUS MISOPROSTOL ON THE UPPER GASTROINTESTINAL-TRACT MUCOSA

Background: This study was developed to compare the incidence of endos copically diagnosed ulcers in elderly patients taking nabumetone, ibup rofen, or concomitant ibuprofen/misoprostol. Further research is indic ated to better establish the clinical relevance of these endoscopy fin dings. Methods: We conducted a prospective, multicenter, randomized, e ndoscopist-blinded, 12-week study involving 171 patients with osteoart hritis aged 60 years and older. Patients were randomized to receive na bumetone, 1000 mg (n=58); ibuprofen, 600 mg four times daily (n=53); o r ibuprofen, 600 mg four times daily, administered concomitantly with misoprostol, 200 mug four times daily (n=60). Endoscopy was performed at baseline and at weeks 2, 6, and 12. Endoscopy results were scored o n a scale of 1 to 9. Significant ulcers were defined as breaks in the mucosa greater than 5 mm with appreciable depth. Results: Of the 171 r andomized patients, 148 completed the study. There was no significant difference in the incidence of significant ulcers between the nabumeto ne group and the ibuprofen/misoprostol group (one vs zero). There were significantly fewer significant ulcers in the nabumetone and ibuprofe n/misoprostol groups than in the ibuprofen monotherapy group (one and zero vs eight; P<.01). There also was a significant difference in the time to ulcer development, with a greater risk of developing an ulcer sooner with ibuprofen treatment (P<.01) than either nabumetone or ibup rofen/misoprostol treatment. The severity of osteoarthritis, based on physicians' assessments, improved in 64% of patients in the nabumetone group, 55% of those in the ibuprofen group, and 63% of those in the i buprofen/misoprostol group. Conclusions: Nabumetone is equivalent in u lcerogenicity to concomitant ibuprofen/misoprostol and is significantl y less ulcerogenic than ibuprofen alone.