Misoprostol may mitigate CV risks conferred by NSAIDs

WASHINGTON — Among veterans assigned nonsteroidal anti-inflammatory drugs, those also assigned misoprostol had reduced risk for CV events associated with nonsteroidal anti-inflammatory drugs, according to findings presented at the American College of Cardiology Scientific Session.

NSAIDs have been associated with elevated risk for events such as MI, cardiac arrest, stroke and acute kidney failure; another known adverse event is stomach ulcers, and misoprostol is sometimes prescribed to people assigned NSAIDs who are at high risk for ulcers, according to the study background.

Mark A. Munger, PharmD, professor of pharmacotherapy at the University of Utah College of Pharmacy, Salt Lake City, and colleagues conducted a retrospective cohort study of veterans from a U.S. Veterans Affairs database (n = 1,687,581) who initiated NSAID and/or misoprostol therapy between 2005 and 2013.

“Right now, clinicians have no direct treatment options to reduce the risk for NSAID-induced cardiorenal complications, other than to advise against NSAID use, reduce the duration of use or recommend alternative pain management agents, so we set out to discover a treatment to reduce the risk of these effects,” Munger said in a press release.

Participants were followed for 5 years for the following events: acute MI, cardiac arrest, ventricular fibrillation, cerebrovascular accident, transient ischemic attack and renal failure.

After propensity-score matching, Munger and colleagues compared 1,827 patients assigned NSAIDs plus misoprostol with 1,827 assigned NSAIDs alone.

Compared with those assigned NSAIDs only, those assigned NSAIDs plus misoprostol had reduced risk for acute MI, cardiac arrest or ventricular fibrillation (HR = 0.56; 95% CI, 0.34-0.94), cerebrovascular accident or TIA (HR = 0.75; 95% CI, 0.6-0.95) or renal failure (HR = 0.66; 95% CI, 0.49-0.89), Munger and colleagues found.

There was no difference between the groups in all-cause mortality (HR = 1.05; 95% CI, 0.87-1.25).

“Our data ... support a potentially safer NSAID alternative when NSAIDs are combined with misoprostol,” Munger said in the release. “Hopefully we can reduce the incidence of NSAID-induced cardiorenal adverse effects, which could be especially important in an era when pain management is in flux.” – by Erik Swain

Reference:

Munger MA, et al. Abstract 1148-069. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Disclosure: Munger reports no relevant financial disclosures.