Determination of candidates for adjunctive 'gastroprotective' prostaglandins

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is now recognized as being frequently associated with asymptomatic gastric ulceration and its complications. Such adverse effects on the gastric mucosa have recently been found to occur with even greater frequency in certain NSAID-treated patients. Synthetic prostaglandin analogues have been shown to be cytoprotective of the gastric mucosa. This benefit has been evidenced by the reduced risk of gastric ulceration and gastric bleeding in patients taking NSAIDs on a prolonged basis. The first synthetic prostaglandin to be approved for this indication is misoprostol (Cytotec). To determine which and how many patients receiving NSAIDs should be treated adjunctively with a cytoprotective prostaglandin to reduce risk of NSAID-induced gastropathy, a clinical study of 100 consecutive patients seen in a rheumatology practice was undertaken. Patients were assessed by interview and chart review. Of these patients, 19% to 30% were considered potential candidates for adjunctive prostaglandin therapy. The rationale for use of the "gastroprotective" prostaglandins appears to lie in the identification of those patients who are especially at high risk for gastric ulcers.