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A Controlled Study Comparing the Effects of Nabumetone, Ibuprofen, and Ibuprofen Plus Misoprostol on the Upper Gastrointestinal Tract Mucosa

Sanford H. Roth, MD; Elizabeth A. Tindall, MD; Adesh K. Jain, MD; F. Gilbert McMahon, MD; Paul A. April, MD; Barry I. Bockow, MD; Stanley B. Cohen, MD; Roy M. Fleischmann, MD
Arch Intern Med. 1993;153(22):2565-2571. doi:10.1001/archinte.1993.00410220073008.
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Background:  This study was developed to compare the incidence of endoscopically diagnosed ulcers in elderly patients taking nabumetone, ibuprofen, or concomitant ibuprofen/misoprostol. Further research is indicated to better establish the clinical relevance of these endoscopy findings.

Methods:  We conducted a prospective, multicenter, randomized, endoscopist-blinded, 12-week study involving 171 patients with osteoarthritis aged 60 years and older. Patients were randomized to receive nabumetone, 1000 mg (n=58); ibuprofen, 600 mg four times daily (n=53); or ibuprofen, 600 mg four times daily, administered concomitantly with misoprostol, 200 μg four times daily (n=60). Endoscopy was performed at baseline and at weeks 2, 6, and 12. Endoscopy results were scored on a scale of 1 to 9. Significant ulcers were defined as breaks in the mucosa greater than 5 mm with appreciable depth.

Results:  Of the 171 randomized patients, 148 completed the study. There was no significant difference in the incidence of significant ulcers between the nabumetone group and the ibuprofen/misoprostol group (one vs zero). There were significantly fewer significant ulcers in the nabumetone and ibuprofen/misoprostol groups than in the ibuprofen monotherapy group (one and zero vs eight; P<.01). There also was a significant difference in the time to ulcer development, with a greater risk of developing an ulcer sooner with ibuprofen treatment (P<.01) than either nabumetone or ibuprofen/misoprostol treatment. The severity of osteoarthritis, based on physicians' assessments, improved in 64% of patients in the nabumetone group, 55% of those in the ibuprofen group, and 63% of those in the ibuprofen/misoprostol group.

Conclusions:  Nabumetone is equivalent in ulcerogenicity to concomitant ibuprofen/misoprostol and is significantly less ulcerogenic than ibuprofen alone.(Arch Intern Med. 1993;153:2565-2571)


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