Combining NSAIDs with misoprostol may reduce risk of cardiovascular side effects

CT scan of the heart

Patients taking non-steroidal anti-inflammatory drugs (NSAIDs) and misoprostol, a drug commonly used to prevent and treat stomach ulcers, have a lower risk of experiencing a serious cardiovascular event compared with patients taking NSAIDs alone, according to research due to be presented at the American College of Cardiology’s 66th Annual Scientific Session.

The study, to be presented as a poster on 17 March 2017, analysed the health records of more than 1.6 million people in the United States Veterans Affairs health system who took prescriptions of NSAIDs and/or misoprostol between 2005 and 2013.

By looking at their baseline health status, the researchers matched 1,827 individuals taking NSAIDs alone with 1,827 individuals taking NSAIDs and misoprostol. The health outcomes of the two groups were then compared over five years. The results showed that the group taking NSAIDs in combination with misoprostol had a 44% lower risk of having ventricular fibrillation, cardiac arrest or a heart attack than those taking NSAIDs alone (hazard ratio [HR] 0.56; 95% confidence interval [CI] 0.34-0.94). The group taking both pills also had a 25% lower risk of having a stroke (HR 0.75; 95% CI 0.60-0.95) and a 34% lower risk of acute kidney failure (HR 0.66; 95% CI 0.49-0.0.89), compared with the group taking just NSAIDs. All-cause mortality was not statistically different between the two groups (HR 1.05; 95% CI 0.87-1.25).

The findings suggest that combining NSAIDs with misoprostol either by prescribing them together or developing a combination pill could help reduce the risk of cardiovascular and renal side effects associated with NSAID use.

Mark Munger, professor of pharmacotherapy at the University of Utah College of Pharmacy and the study’s lead author, says: “The study results may apply to all patients who take NSAIDS, but more specifically to those who take them early in treatment, in higher doses, or for longer durations of treatment.”

Munger says that he hopes the study will help reduce the incidence of NSAID-induced cardiovascular and renal adverse effects “in an era in which pain management is in flux”.

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Citation
The Pharmaceutical Journal, PJ, March 2017, Vol 298, No 7899;298(7899):DOI:10.1211/PJ.2017.20202437