IMIDAZOLE SALICYLATE VERSUS PIROXICAM IN THE TREATMENT OF ARTHROSIS IN ELDERLY PATIENTS - A DOUBLE-BLIND CLINICAL AND ENDOSCOPIC TRIAL

The clinical efficacy and gastroduodenal tolerability of imidazole salicylate (imidazole 2‐hydroxybenzoate, ITF 182), a new synthetic drug with an anti‐inflammatory action, was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis. Of the 41 patients entering the trial, only 38 completed the protocol (6 men and 32 women; mean age, 71; range, 65–80 years). After upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions, the patients were allocated at random, according to a double‐blind, double‐dummy protocol, to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks. Imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis, although its efficacy was inferior to that of piroxicam. Grade 2 gastric mucosal lesions were detected in 1 of 20 patients (5%) treated with imidazole salicylate; lesions corresponding to grades 2, 3, and 4 were found in 6 of 18 (33%) of those treated with piroxicam (P = .034). Painful dyspepsia was reported by 15% of the patients in the imidazole salicylate group and by 28% of those in the piroxicam group. On the basis of these results and under the experimental conditions adopted in this trial, the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly. As an anti‐inflammatory drug endowed with probably less marked analgesic activity compared with piroxicam, its use is suggested for the treatment of minor arthropathy. Further study, however, is necessary to define more completely the effects of this new drug on gastric and duodenal mucosa. 1990 The American Geriatrics Society