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Misoprostol and Gastrointestinal Complications in Patients Taking Nonsteroidal Anti-Inflammatory Drugs for Rheumatoid Arthritis
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Silverstein and colleagues [1] describe a large number of patients in their study, yet the cited numbers of severe complications (25 definite events in the misoprostol group compared with 42 in the placebo group) are small. The authors state that the “40% reduction … is maintained in patients with any of the four risk factors or combination of risk factors.” The absolute numbers might have been presented to allow the reader to evaluate these subgroups, but such numbers would indeed be smaller and would not pass tests of statistical significance.
Some evidence suggests that enteric coated aspirin is effective and is not associated with a high risk for adverse effects [2]. Analgesic doses of enteric coated aspirin were effective in 436 patients with chronic rheumatoid arthritis and were associated with almost no risk for severe gastrointestinal complications [3]. Silverstein and colleagues' study included 632 patients receiving aspirin, but enteric coated aspirin is not mentioned.
A local pharmacy indicated that the monthly patient cost of enteric coated aspirin (300 tablets) is $8.00. The cost for comparable doses of ibuprofen was $16.50. Other NSAIDs cost from $23.00 to $70.00 per month at usual doses. Patients vary, and some who may not get relief from enteric coated aspirin do respond to another NSAID. Why do the authors emphasize the use of the more expensive NSAIDs? Adding $90.00 per month for misoprostol to prevent a few severe complications is hardly logical, as pointed out in Dr. Levine's editorial [4].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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