Misoprostol in the Treatment and Prevention of Nonsteroidal Anti-Inflammatory Drug-Induced Gastrointestinal Mucosal Injury

Three studies are discussed with regard to the efficacy of misoprostol,a synthetic prostaglandin Et analogue, in the treatment and prevention ofNSAID-induced gastroduodenal lesions in patients with rheumatoid arthritisand osteoarthritis. ln the treatment study, misoprostol was found to be highlyeffective in healing aspirin-induced gastroduodenal lesions, eg, intramucosalhemorrhage, erosions, and gastric and duodenal ulcers, in patients with rheumatoidarthritis continuing NSAID therapy. Treatment successes were reported in60% ( week 4) and 70% ( week 8) of patients receiving misoprostol compared with31% (week 4) and 25% (week 8) of patients receiving placebo (P=0.0001).Furthermore, misoprostol did not adversely affect anti-inflammatory and analgesicefficacy of aspirin in rheumatoid arthritis. ln one prevention study, misoprostolco-administered with therapeutic doses of NSAIDs, was found co be safeand effective in preventing NSAID-induced gastric ulcers in osteoarthriticpatients. At week 12, 94% of patients on 100 μg misoprostol qid were ulcer-freeversus 99% on 200 μg misoprostol qid and 78% on placebo (P<0.001 ). In a secondprevention study the preliminary analysis of data showed the superior efficacy ofmisoprostol compared to sucralfate in preventing NSAID-induced gastric ulcers.New findings from research on prostaglandin analogues suggest that they mayhave therapeutic applications beyond the prevention and treatment of NSAID-inducedgastrointestinal mucosal damage. Misoprostol may protect against-NSAID inducedrenal dysfunction, may reduce the damage to cartilage that has beenassociated with some NSAIDs, and is associated with a reduction in the incidenceof rejection crises as well as with improvement in renal function in patientsundergoing renal transplantation