High‐dose ranitidine for the prevention of recurrent peptic ulcer disease in rheumatoid arthritis patients taking NSAIDs

• Published in: Alimentary pharmacology & therapeutics Vol. 10; no. 3; pp. 347 - 351
• Main Authors: Ten Wolde, S, Dijkmans, BA, Janssen, M, Hermans, J, Lamers, CB
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.06.1996; Blackwell
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Digestive system; Double-Blind Method; Female; Gastroscopy; Humans; Male; Medical sciences; Middle Aged; Peptic Ulcer - chemically induced; Peptic Ulcer - drug therapy; Peptic Ulcer - prevention & control; Pharmacology. Drug treatments; Ranitidine - administration & dosage; Ranitidine - therapeutic use; Recurrence; Human; Immunopathology; Toxicity; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Non steroidal antiinflammatory agent; Prevention; Chemotherapy; Chronic; H2 receptor; Rheumatoid arthritis; Digestive diseases; Antagonist; High dose; Anastomotic ulcer; Gastric disease
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.0953-0673.1996.00347.x

BACKGROUND: Continuous therapy with low‐dose ranitidine (150 mg b.d.) is known to be effective for the prevention of recurrent nonsteroidal anti‐inflammatory drug (NSAID)‐associated duodenal ulcer but not for gastric ulcer. AIM: To investigate, in a double‐blind placebo‐ controlled study, the preventive effect of a high dose of ranitidine (300 mg b.d.) on the recurrence of both duodenal ulcers and gastric ulcers in rheumatoid arthritis patients with a continuous need for NSAIDs. METHODS: Rheumatoid arthritis patients with a history of peptic ulcer disease were randomized to receive either ranitidine 300 mg b.d. or placebo for 12 months. Endoscopy was performed at study entry and after 6 and 12 months. End‐point was the recurrence of gastric or duodenal ulcers. RESULTS: The study was stopped after a blinded interim analysis; at that time 10 of the 15 included patients in each treatment group were evaluable. Recurrent duodenal ulcers had occurred in four patients treated with placebo and none of the patients treated with ranitidine (Fisher's exact one‐tailed P = 0.04; 95% CI, ‐ 0.70 to ‐ 0.10). Recurrent gastric ulcers had occurred in six patients in the placebo group and three patients in the ranitidine group (Fisher's exact one‐tailed P = 0.18; 95% CI, ‐0.72 to 0.12). Two patients in the placebo group had developed both duodenal ulcers and gastric ulcers. No adverse events were observed. CONCLUSIONS: High dose ranitidine is effective for the prevention of recurrent duodenal ulcer but not for recurrent gastric ulcer in rheumatoid arthritis patients taking NSAIDs.