Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 19 February 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

COX2 inhibitor vs other anti-inflammatory drugs for osteoarthritis

Results of an international multi-center study in this week's issue of the Lancet suggest that the COX2 inhibitor lumiracoxib could be an effective treatment for osteoarthritis.

News image

fiogf49gjkf04

The use of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) is widespread to reduce the pain associated with osteoarthritis. However, these can lead to gastrointestinal ulcer complications, accounting for around 7000 deaths each year in the United States and 1000 deaths in the United Kingdom.

The development of cyclo-oxygenase 2 (COX2)-selective inhibitors should reduce these ulcer complications, but evidence is limited.

In this study, doctors from the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) assessed gastrointestinal and cardiovascular safety of the COX2 inhibitor lumiracoxib compared with the NSAIDs naproxen and ibuprofen.

The team randomized 18325 osteoarthritis patients (aged ≥50 years) to receive either lumiracoxib (n = 9156), naproxen (n = 4754), or ibuprofen (n = 4415) for1 year.

The doctors found that the risk of ulcer complications was reduced in patients given lumiracoxib, compared with patients using NSAIDs. However, this benefit did not apply for patients who were also taking aspirin.

The team found that the incidence of non-fatal and silent myocardial infarction, stroke, or cardiovascular death - which was low in the population - did not differ significantly between treatment groups.

"The fact that we enrolled osteoarthritis patients in the study who already had high blood pressure or other risk factors for coronary heart disease was important," says Dr Michael Farkouh from the New York University School of Medicine, USA.

Dr Michael Doherty, from the University of Nottingham, England, commented, "Lumiracoxib showed a 3 to 4-fold reduction in ulcer complications compared with NSAIDs without an increase in the rate of serious cardiovascular events, suggesting that lumiracoxib is an appropriate treatment for patients with osteoarthritis".
The risk of ulcer complications was reduced in patients given lumiracoxib.
Lancet

The TARGET study is critically evaluated in an accompanying commentary by Drs Eric Topol and Gary Falk from the Cleveland Clinic Foundation, USA. With regard to cardiovascular outcomes they comment, "The overall low frequency of myocardial events is important to put in context".

"Patients in TARGET were 50 years or older and nearly all those with myocardial infarction, stroke, coronary artery bypass surgery, or congestive heart failure were excluded."

"Less than 2% of the patients had a previous myocardial infarction or a revascularization procedure."

"Unfortunately, this trial, like all others in the clinical development of coxibs, purposefully excluded patients with known and significant pre-existing coronary artery disease."

Drs Topol and Falk also highlight concerns about lumiracoxib’s liver toxicity and potential increase in heart attack if lumiracoxib is compared with naproxen alone, "TARGET quantifies lumiracoxib’s narrow benefit over 2 NSAIDs with a trade-off."

"For patients not taking aspirin, there is an absolute reduction of 0•72% in ulcer complications, with an excess of 2•0% of liver function test abnormalities."

"The putative benefit is further compromised if naproxen is the NSAID, with a 0•17% excess of myocardial infarction."

"For patients taking low-dose aspirin, it is hard to justify the coxib: there is no benefit in ulcer complication reduction, but the risk of myocardial infarction and hepatotoxicity persist."

Lancet 2004; 364(9435): 639, 665, 675
20 August 2004

Go to top of page Email this page Email this page to a colleague

 19 February 2018 
Screening colonoscopy in the right and left colon
 19 February 2018 
NAFLD prevalence in the USA
 19 February 2018 
Fructans in children with IBS

 16 February 2018 
Undetected celiac in the elderly
 16 February 2018 
Inflammatory bowel diseases are global diseases
 16 February 2018 
Fructans induce non-celiac gluten sensitivity
 15 February 2018 
Oral direct-acting antiviral treatment for Hep C virus genotype 1
 15 February 2018 
NSAIDS and GI damage
 15 February 2018 
Primary vs secondary surgery for the presence of lymph node metastasis
 14 February 2018 
Management of hemorrhoids in the USA
 14 February 2018 
Predicting adenoma detection rate
 14 February 2018 
Normal bowel frequency characterization in the USA 
 13 February 2018 
Prebiotics improve endothelial dysfunction
 13 February 2018 
Personalising treatment options for IBS
 13 February 2018 
Diagnostic criteria for a Rome IV functional gastrointestinal disorders
 12 February 2018 
Visceral hypersensitivity and functional GI disorders
 12 February 2018 
Depression and aggressive IBD
 12 February 2018 
Variability in interpretation of endoscopic findings impacts patient management
 09 February 2018 
Treatment of choice for anastomotic stricture in IBD
 09 February 2018 
PRO measurement information system 
 09 February 2018 
Overall disease severity indices for IBD
 08 February 2018 
Prediction of endoscopically active disease

 08 February 2018 
Steroid-refractory acute severe ulcerative colitis
 08 February 2018 
Decision aid used by IBD patients
 07 February 2018 
Ursodeoxycholic acid combined with bezafibrate for itching
 07 February 2018 
Change in microbiome in gastritis vs gastric carcinoma
 07 February 2018 
Colorectal cancer and primary sclerosing cholangitis-IBD
 06 February 2018 
Risk of death after liver transplantation
 06 February 2018 
Crohn’s disease vs refractory pouchitis
 06 February 2018 
Support for functional dyspepsia symptom diary
 05 February 2018 
Helicobacter spp influence on GI tract 
 05 February 2018 
No link found between severe reflux and all-cause mortality 
 05 February 2018 
Psychological distress in PPI non-responders
 02 February 2018 
Assessing psychosexual impact of IBD
 02 February 2018 
Decrease in overall mortality with cholera vaccination
 02 February 2018 
Diagnostic performance of fecal immunochemical tests
 01 February 2018 
Screening frequency with family histories of colorectal cancer
 01 February 2018 
IBD and sport participation
 01 February 2018 
Life with a stoma 
 31 January 2018 
Aprepitant and gastroparesis 
 31 January 2018 
Anesthesia risk in colonoscopy
 31 January 2018 
GED-0301 for Crohn's Disease
 30 January 2018 
Intestinal dysbiosis and allergic diseases in infants
 30 January 2018 
Fructans and IBS symptoms in children
 29 January 2018 
Dosing calculator for therapy optimization in IBD
 29 January 2018 
Glecaprevir–pibrentasvir for in HCV
 29 January 2018 
Food allergen injections in eosinophilic esophagitis
 29 January 2018 
Reliability of the IBD index
 26 January 2018 
Tofacitinib vs biological therapies for ulcerative colitis
 26 January 2018 
Optimizing selection of biologics in IBD
 26 January 2018 
Nutritional risk and laparoscopic-assisted gastrectomy outcomes
 25 January 2018 
Patient-reported outcome measure for functional dyspepsia
 25 January 2018 
Predicting intra-abdominal infections after colorectal surgery
 25 January 2018 
Predictors of gastric cancer risk
 24 January 2018 
Risk factors underlying previously undiagnosed cirrhosis
 24 January 2018 
Ethnicity influences phenotype in IBD
 24 January 2018 
Bariatric surgery vs medical obesity treatment
 23 January 2018 
Atrophic gastritis after H. pylori eradication
 23 January 2018 
Ectopic pregnancy in women with IBD
 23 January 2018 
Celiac disease in IBS in the USA

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us