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Letters |15 May 1996

Misoprostol and Gastrointestinal Complications in Patients Taking Nonsteroidal Anti-Inflammatory Drugs for Rheumatoid Arthritis

Fred E. Silverstein, MD; G. Steven Geis, PhD, PhD, MD

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  • University of Washington Medical School, Seattle, WA 98195 G. D. Searle & Co. Skokie, IL 60077
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IN RESPONSE:
We appreciate the responses to our article [1]. We agree that the concept of NNT raised by Dr. Wendel and by Madhok and colleagues is important. Using the formula NNT = 1/(riskplacebo − riskmisoprostol), we determined that the NNT was 263 for the 67 serious NSAID-related gastrointestinal events we observed. For those patients at higher risk, however, the NNT to avert a gastrointestinal complication becomes much smaller. For example, for patients with previous peptic ulcer disease, the NNT is 53.
We recently completed additional analyses of the 242 events reported as suspected NSAID-induced complications. These events include patients who present with gastrointestinal symptoms while receiving an NSAID that might indicate an NSAID-related complication and therefore might have both clinical and economic consequences. To understand the full effect of the cost of NSAID-related complications and the role of misoprostol in reducing them, these cases must also be considered because the symptoms resulted in a medical work-up, whether or not a complication actually occurred [2].
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Silverstein FE, Geis GS. Misoprostol and Gastrointestinal Complications in Patients Taking Nonsteroidal Anti-Inflammatory Drugs for Rheumatoid Arthritis. Ann Intern Med. ;124:927. doi: 10.7326/0003-4819-124-10-199605150-00018

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Published: Ann Intern Med. 1996;124(10):927.

DOI: 10.7326/0003-4819-124-10-199605150-00018

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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