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COX-2 inhibitors or nonselective NSAIDs plus gastroprotective agents

The most recent issue of the Alimentary Pharmacology & Therapeutics considers what agents to prescribe in daily clinical practice to prevent upper gastrointestinal events.

News image

Two strategies for prevention of upper gastrointestinal events for nonselective nonsteroidal anti-inflammatory drug users are replacement of the nonselective nonsteroidal anti-inflammatory drug by a cyclo-oxygenase-2-selective inhibitor  or co-prescription of a gastroprotective agent.

Dr Masclee and colleagues from The Netherlands identified whether and in whom either of these strategies should be preferred in daily practice.

The team conducted a nested case–control study using 3 European primary care databases.

The researchers selected a cohort including all naive nonselective nonsteroidal anti-inflammatory drug+GPA and coxib users aged 50 years.

Cases with an upper gastrointestinal event were matched to cohort members without an upper gastrointestinal event on age, sex and number of individual upper gastrointestinal risk factors and calendar time.

398 upper gastrointestinal cases were identified
Alimentary Pharmacology & Therapeutics

Within the nonselective nonsteroidal anti-inflammatory drug cohort, 398 upper gastrointestinal cases were identified.

The research team found that the risk of upper gastrointestinal events was equivalent for coxib and nonselective nonsteroidal anti-inflammatory drug+GPA users.

In concurrent glucocorticoid users, the risk of upper gastrointestinal events was significantly elevated for nonselective nonsteroidal anti-inflammatory drug+GPA compared with coxib users.

Dr Masclee's team commented, "The risk of upper gastrointestinal events was similar in nonselective nonsteroidal anti-inflammatory drug+GPA and coxibs users."

"In patients concurrently using glucocorticoids, a significant increase in the risk of upper gastrointestinal events for nonselective nonsteroidal anti-inflammatory drug+GPA users was observed and coxibs should be preferred."

Aliment Pharmacol & Ther 2013: 38(2): 178–189
05 July 2013

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