Abstract
Three studies are discussed with regard to the efficacy of misoprostol, a synthetic prostaglandin Et analogue, in the treatment and prevention of NSAID-induced gastroduodenal lesions in patients with rheumatoid arthritis and osteoarthritis. ln the treatment study, misoprostol was found to be highly effective in healing aspirin-induced gastroduodenal lesions, eg, intramucosal hemorrhage, erosions, and gastric and duodenal ulcers, in patients with rheumatoid arthritis continuing NSAID therapy. Treatment successes were reported in 60% ( week 4) and 70% ( week 8) of patients receiving misoprostol compared with 31% (week 4) and 25% (week 8) of patients receiving placebo (P=0.0001). Furthermore, misoprostol did not adversely affect anti-inflammatory and analgesic efficacy of aspirin in rheumatoid arthritis. ln one prevention study, misoprostol co-administered with therapeutic doses of NSAIDs, was found co be safe and effective in preventing NSAID-induced gastric ulcers in osteoarthritic patients. At week 12, 94% of patients on 100 μg misoprostol qid were ulcer-free versus 99% on 200 μg misoprostol qid and 78% on placebo (P<0.001 ). In a second prevention study the preliminary analysis of data showed the superior efficacy of misoprostol compared to sucralfate in preventing NSAID-induced gastric ulcers. New findings from research on prostaglandin analogues suggest that they may have therapeutic applications beyond the prevention and treatment of NSAID-induced gastrointestinal mucosal damage. Misoprostol may protect against-NSAID induced renal dysfunction, may reduce the damage to cartilage that has been associated with some NSAIDs, and is associated with a reduction in the incidence of rejection crises as well as with improvement in renal function in patients undergoing renal transplantation.