Misoprostol Reduces Serious Gastrointestinal Complications in Patients with Rheumatoid Arthritis Receiving Nonsteroidal Anti-Inflammatory Drugs

Silverstein, Fred E.; Graham, Daniela; Senior, John R.; Davies, Helen W.; Struthers, Barbara J.; Bittman, Richard M.; Geis, Gilbert

doi:10.7326/0003-4819-123-4-199508150-00001

Cited by 968 publications

(572 citation statements)

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“…The following approaches may be considered for patients with RA who would benefit from an NSAID but who are at increased risk of serious adverse GI effects: use of low-dose prednisone instead of an NSAID, use of a nonacetylated salicylate, use of a highly selective COX-2 inhibitor, or use of a combination of an NSAID and a gastroprotective agent. Gastroprotective agents, which are effective in decreasing NSAID-associated gastroduodenal ulceration, include high-dose H 2 blockers (45), proton-pump inhibitors (46,47), and oral prostaglandin analogs (48).…”

Section: Pharmacologic Treatment Of Ramentioning

confidence: 99%

Guidelines for the management of rheumatoid arthritis: 2002 Update

2002

Arthritis & Rheumatism

1,165

176

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Section: Pharmacologic Treatment Of Ramentioning

confidence: 99%

Guidelines for the management of rheumatoid arthritis: 2002 Update

2002

Arthritis & Rheumatism

1,165

176

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“…Clinically significant ulcer complications include symptomatic ulcers, ulcer hemorrhages, and ulcer perforations (5). We identified 5 trials reporting these complications in patients receiving NSAID NS agents (7)(8)(9)(10)24). The mean annualized rate of ulcer complications is 3.0% per year, and we adopted this as our base-case estimate for average-risk patients in the NSAID NS strategy.…”

mentioning

confidence: 99%

Minimizing complications from nonsteroidal antiinflammatory drugs: Cost‐effectiveness of competing strategies in varying risk groups

Spiegel¹,

Chiou²,

Ofman³

2005

Arthritis & Rheumatism

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Objective. To appraise the cost-effectiveness of competing therapeutic strategies in patient cohorts eligible for aspirin prophylaxis with varying degrees of gastrointestinal (GI) and cardiovascular risk. Methods. Cost-effectiveness and cost-utility analyses were performed to evaluate 3 competing strategies for the management of chronic arthritis: 1) a generic nonselective nonsteroidal antiinflammatory drug (NSAID NS ) alone; 2) NSAID NS plus a proton pump inhibitor (PPI); and 3) a cyclooxygenase 2-selective inhibitor (coxib) alone. Cost estimates were from a third-party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use. Results. In average-risk patients, the NSAID NS ؉ PPI strategy costs an incremental $45,350 per additional ulcer complication avoided and $309,666 per QALY gained compared with the NSAID NS strategy. The coxib strategy was less effective and more expensive than the NSAID NS ؉ PPI strategy. Sensitivity analysis revealed that the NSAID NS ؉ PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with >1 risk factor for a GI complication). Conclusion. Generic nonselective NSAIDs are most cost-effective in patients at low risk for an adverse event. However, the addition of a PPI to a nonselective NSAID may be the preferred strategy in patients taking aspirin or otherwise at high risk for a GI or cardiovascular adverse event.

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“…This cumbersome regimen was overcome by combining an NSAID (diclofenac) with misoprostol, in the form of Arthrotec (G. D. Searle & Co., New York, NY). Arthrotec coordinates the timing of release of the diclofenac to that of misoprostol, insuring the desired timing and equivalent GI safety to that observed with 3-4 daily doses of misoprostol (6,7). Therefore, Arthrotec can be prescribed as 1 or 2 tablets per day.…”

mentioning

confidence: 99%

Cardiovascular and gastrointestinal risks of nonsteroidal antiinflammatory drugs revisited: Comment on the article by the American College of rheumatology Ad Hoc group on use of selective and nonselective nonsteroidal antiinflammatory drugs

Rothschild¹

2009

Arthritis & Rheumatism

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Misoprostol Reduces Serious Gastrointestinal Complications in Patients with Rheumatoid Arthritis Receiving Nonsteroidal Anti-Inflammatory Drugs

Abstract: In older patients with rheumatoid arthritis, misoprostol reduced serious NSAID-induced upper gastrointestinal complications by 40% compared with placebo.

Cited by 968 publications

References 0 publications

Guidelines for the management of rheumatoid arthritis: 2002 Update

Guidelines for the management of rheumatoid arthritis: 2002 Update

Minimizing complications from nonsteroidal antiinflammatory drugs: Cost‐effectiveness of competing strategies in varying risk groups

Cardiovascular and gastrointestinal risks of nonsteroidal antiinflammatory drugs revisited: Comment on the article by the American College of rheumatology Ad Hoc group on use of selective and nonselective nonsteroidal antiinflammatory drugs

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