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The recent report by Graham et al¹ provides much needed insights into the comparative benefits of 2 gastroprotective therapies: misoprostol and the proton pump inhibitor lansoprazole. Clinicians are now especially eager for evidence-based guidance in the treatment of patients who have a history of endoscopically documented gastric ulceration without Helicobacter pylori infection and who require long-term therapy with a nonsteroidal anti-inflammatory drug (NSAID). However, the use of misoprostol (200 µg 4 times a day [800 µg/d], the maximum recommended dose) does not reflect the current realities of clinical practice.

In Graham and colleagues' 12-week study, misoprostol (200 µg 4 times a day) was clearly superior to lansoprazole (15 or 30 mg/d) for the prevention of gastric ulcers in the analysis of patients who were continuing to receive therapy. The significant treatment differences disappeared, however, in the intention-to-treat analysis, which counted patients who discontinued therapy for any reason as treatment failures. . . . [Full Text of this Article]

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