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Prevention of NSAID-induced gastroduodenal ulcersRostom A, Dube C, Wells GA, Tugwell P, Welch V, Jolicoeur E, McGowan JL
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SummaryPrevention of NSAID-induced gastroduodenal ulcersThe results of this meta-analysis demonstrate that misoprostol, proton pump inhibitors, and double doses of H2-receptor antagonists are effective at reducing the risk of both endoscopic gastric and duodenal NSAID induced ulcers. Standard doses of H2-receptor antagonists are not effective at reducing the risk of NSAID induced gastric ulcers. Misoprostol is the only prophylactic agent to date that has been evaluated in a true clinical outcome trial, and has been shown to reduce the risk of NSAID related ulcer complications. However, its use is associated with significant adverse effects particularly at higher doses.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 24. 2000 AbstractBackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are important agents in the management of arthritic and inflammatory conditions, and are among the most frequently prescribed medications in North America and Europe. However, there is overwhelming evidence linking these agents to a variety of gastrointestinal (GI) toxicities. ObjectivesTo review the effectiveness of common interventions for the prevention of NSAID induced upper GI toxicity. Search strategyA literature search was conducted, according to the Cochrane methodology for identification of randomized controlled trials in electronic databases, including MEDLINE from 1966 to August 2004, Current Contents for six months prior to August 2004, EMBASE to August 2004, and a search of the Cochrane Controlled Trials Register from 1973 to 2004. Biosis Previews®, ADIS LMS Drug Alerts, Pharmaceutical News Index (PNI)® were searched to June 2002. New articles since the last search update were evaluated. Recent conference proceedings were reviewed and content experts and companies were contacted. Selection criteriaRandomized controlled clinical trials (RCTs) of prostaglandin analogues (PA), H2-receptor antagonists (H2RA) or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper GI toxicity were included. Data collection and analysisTwo independent reviewers extracted data regarding population characteristics, study design, methodological quality and number of patients with endoscopic ulcers, ulcer complications, symptoms, overall drop-outs, drop outs due to symptoms. Dichotomous data was pooled using RevMan. Heterogeneity was evaluated using a chi square test. Main resultsForty RCTs met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 ug/day was superior to 400 ug/day for the prevention of endoscopic gastric ulcers (RR=0.17, and RR=0.39 respectively, p=0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800 ug/day than 400 ug/day (p=0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Authors' conclusionsMisoprostol, PPIs, and double dose H2RAs are effective at preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only Misoprostol 800ug/day has been directly shown to reduce the risk of ulcer complications such as perforation hemorrhage or obstruction. |