Does misoprostol reduce risk of NSAID-induced kidney injury?

Misoprostol, a prostaglandin E1 analogue used to prevent nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal disorders, appears effective in preventing kidney injury associated with chronic NSAID use, but the quality of evidence is very low, results of a recent study have shown.

A team of investigators identified randomized controlled trials comparing misoprostol with placebo in an adult patient population. They gauged the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Kidney injury was the primary outcome, while severe adverse events were secondary.

Twelve studies met the eligibility criteria for the meta-analysis. The rates of kidney injury and severe adverse events did not differ significantly between patients treated with misoprostol and those who received placebo.

However, a post hoc subgroup analysis that excluded studies in which different NSAIDs were used in the misoprostol and placebo groups revealed that the former was associated with a reduced risk of NSAID-induced kidney injury (risk difference, ‒0.09, 95 percent confidence interval, ‒0.15 to ‒0.03; p<0.01; I², 87 percent; evidence of very low certainty).

“Misoprostol possibly contributes to reducing the risk of kidney injury associated with chronic NSAID use,” the investigators said. “The findings of this meta-analysis suggest further high-quality clinical trials are warranted.”