A Canadian research team compared rates of upper gastrointestinal (GI) hemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX-2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs).
They used administrative data, from 17 April 2000 to 31 March 2001, in order to identify population based, NSAID-naive cohorts of patients.
The patients in the study were aged 66 years or over.
They had all started taking non-selective NSAIDs (n = 5391), diclofenac plus misoprostol (n = 5087), and rofecoxib (n = 14,583), or celecoxib (n = 18,908) at the beginning of the study.
| Non-selective NSAIDs increased GI hemorrhage risk 4-fold, compared to controls.
| British Medical Journal |
In addition, randomly selected control patients, who had not been exposed to NSAIDs, were studied (n = 100,000).
The team looked at the rate ratios of hospital admission for upper GI hemorrhage in each drug cohort. These were adjusted for potential confounders.
Analysis revealed an increased short term risk of upper GI hemorrhage for users of non-selective NSAIDs (adjusted rate ratio, 4.0), diclofenac plus misoprostol (3.0), and rofecoxib (1.9). However, this was not the case for celecoxib (1.0).
Further analysis showed that, relative to celecoxib, significantly higher risks of upper GI hemorrhage were observed for non-selective NSAIDs (adjusted rate ratio, 4.4), diclofenac plus misoprostol (3.2), and rofecoxib (1.9).
While, relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper GI hemorrhage (adjusted rate ratio, 1.9).
Dr Muhammad Mamdani's team concluded that, "There is a lower short term risk of upper GI hemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs".