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Misoprostol enhances the analgesic activity of NSAIDs 40 million people worldwide rely on daily doses of NSAID to treat the pain and inflammation of arthritis, about 25% develop ulcers. This is related to significant mortality largely due to NSAID-related gastrointestinal bleeds. The risk of gastrointestinal side effects resulting from NSAID use increases with age - unfortunately so does the use of this class of analgesia. This side effect has prompted the development of COX-2 specific inhibitors which are generally accepted to reduce inflammation without destroying the gut lining. Considerable attention has recently been paid to the advantages of non-selective versus COX-2 selective NSAIDS and it has recently been demonstrated that, in arthritis patients, the two classes of drug are equally efficacious, supporting, on the basis of toxicity, the use of COX-2 inhibitors. An alternative strategy has involved the use of misoprostol as an adjunct to non-selective NSAIDS, even though misoprostol itself has GI side effects. In a recent publication, Temple University researchers show that misoprostol has analgesic effects that are additive with those of NSAIDs. In this context it is highly exciting that Taiwanese researchers have developed a new and improved formulation of misoprostol that is likely to offer longer and improved protection against GI injury with fewer side-effects (click here for free access to our recent dossier overviewing this licensing option). The combination of this formulation of misoprostol with NSAIDs could therefore offer a therapy with a similar safety/side effect profile to that of COX-2 inhibitors but with an improved analgesic effect. Clinical studies to investigate this possibility are eagerly awaited. Link to journal abstract:
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