Robinson and colleagues reviewed the results of four randomized, double-blind, placebo-controlled studies which investigated ranitidine as prophylaxis for NSAID-associated damage.

Overall, 673 patients receiving therapeutic dosages of NSAIDs for arthritic or musculoskeletal conditions also received either ranitidine 150 mg twice daily (n= 343) or placebo (n= 330) for four weeks (in two studies) or eight weeks (in two studies). Endoscopic grading of mucosal lesions was done on the basis of a modified Lanza scoring system. All patients had normal baseline endoscopies.

• After four weeks of treatment, there was a significant protective effect against duodenal mucosal lesions including duodenal ulcers in three studies and against gastric mucosal lesions including gastric ulcers in one study, in patients who had received ranitidine, compared with those who had received placebo.
• A meta-analysis of the four studies demonstrated that significantly lesser number of patients given ranitidine developed duodenal ulcers compared to those given placebo (1% vs. 6%, P= 0.01).
• Endoscopic findings at eight weeks from two longer-term studies demonstrated that duodenal ulcers occurred in ranitidine-treated patients at a rate of 1% (2/137) compared to 8% (10/126) in placebo-treated patients, in one trial, and at a rate of 0% (0/57) vs. 8% (4/49) (P= 0.02), respectively, in the other trial.

It was concluded that ranitidine is effective for preventing NSAID-associated duodenal ulcers and may act as an appropriate prophylaxis for some high-risk patients.

Source: Robinson M, Mills RJ, Euler AR. Ranitidine prevents duodenal ulcers associated with non-steroidal anti-inflammatory drug therapy. Aliment Pharmacol Ther. 1991 Apr;5(2):143-50.