Help
Subscribe


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

 22 May 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

 22 May 2018 
Worldwide H.pylori prevalence
 22 May 2018 
PPI and risk of stroke
 22 May 2018 
Online tool predicts bowel dysfunction severity prior to anterior resection
 21 May 2018 
Fecal incontinence and quality of life in IBD
 21 May 2018 
PPI use and cognitive decline
 21 May 2018 
Depressive symptoms in IBD youth
 18 May 2018 
Esophageal dilatation in clinical practice 
 17 May 2018 
IBD and later extraintestinal manifestations
 17 May 2018 
Repeat stool DNA testing
 17 May 2018 
IBS and chronic fatigue following GI infection
 16 May 2018 
Factors associated with fecal incontinence
 16 May 2018 
Diagnostic delay in Crohn's disease
 16 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 15 May 2018 
Guidelines for management of Crohn's
 15 May 2018 
New therapies for CDI
 15 May 2018 
Hep B in the Grey Zone
 14 May 2018 
Blood test for the diagnosis of fibrotic NASH
 14 May 2018 
Outcomes at bariatric centers of excellence
 14 May 2018 
Management of perianal fistulas in Crohn’s
 11 May 2018 
Detection of undiagnosed celiac disease
 11 May 2018 
Alcohol consumption and drug-induced liver injury
 10 May 2018 
Post‐operative complications in elderly IBD
 10 May 2018 
Colorectal cancer screening
 10 May 2018 
Fibrosis in patients with chronic hepatitis B
 09 May 2018 
Fecal incontinence
 09 May 2018 
Health problems and IBS
 09 May 2018 
Esophageal dilatation in clinical practice 
 07 May 2018 
Omitting antibiotics in uncomplicated acute diverticulitis
 07 May 2018 
Health problems and IBS
 07 May 2018 
Assessment of diminutive colorectal polyps
 04 May 2018 
Factors associated with fecal incontinence
 04 May 2018 
National Institutes of Health workshop and obesity
 04 May 2018 
Colorectal cancer screening and ethnic inequities
 03 May 2018 
Gastrointestinal ultrasound in IBD
 03 May 2018 
Ultransonography in postsurgical recurrence in Crohn's
 02 May 2018 
Symptom assessment in cirrhotic ascites
 02 May 2018 
Hep C antiviral treatment and liver cancer risk
 02 May 2018 
Chronic Hep B
 01 May 2018 
European guidelines on pancreatic cystic neoplasms
 01 May 2018 
Interferon‐free regimens in Hep C
 01 May 2018 
Age at IBD onset and extraintestinal complications
 30 April 2018 
Formula for preterm infants
 30 April 2018 
Primary antibiotic resistance and sequential therapy for H. pylori
 30 April 2018 
Patient-reported outcome measures in IBD trials
 27 April 2018 
Anxiety scale for chronic esophageal disease
 27 April 2018 
Disease activity in eosinophilic esophagitis
 27 April 2018 
Eastern and western practices for endoscopic resection of colorectal lesions
 26 April 2018 
Obesity and physical activity in diverticulosis
 26 April 2018 
Primary sclerosing cholangitis in the USA
 25 April 2018 
Aspirin and pancreatic cancer
 25 April 2018 
Central mediators of irinotecan-induced steatohepatitis
 25 April 2018 
Neuroimaging in Hep C
 24 April 2018 
Scoring system identifies cancer risk in Barrett's
 24 April 2018 
Microbiome in athletes vs sedentary subjects
 23 April 2018 
Genome-wide study on HBV-related acute-on-chronic liver failure
 23 April 2018 
Antibody suitable for further clinical development to complement existing therapeutic strategies for HCV
 23 April 2018 
Sleep deprivation and NAFLD in the USA
 20 April 2018 
Two annexin A11 epitopes targeted by IgG1 and IgG4 autoantibodies were shared between patients with IAC/AIP and IgG4 antibodies blocked binding of IgG1 antibodies to the shared annexin A11 epitopes
 20 April 2018 
Adalimumab with azathioprine in Crohn's
 19 April 2018 
c-Myc expression and pancreatic cancer

Blackwell Publishing


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