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 25 February 2018

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News

COX-2 inhibitors do not provide greater stomach protection

There is no evidence that the new generation of anti-inflammatory drugs are less harmful to the stomach lining than many traditional anti-inflammatory drugs, concludes a study in this week's BMJ.

News image

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COX-2 inhibitors are a new generation of anti-inflammatory drugs.

These drugs were designed to provide pain relief without the serious gastrointestinal side effects associated with traditional non-steroidal anti-inflammatory drugs.

Dr Julia Hippisley-Cox and colleagues identified patients from 367 UK general practices.

The patients had a first ever diagnosis of an upper gastrointestinal event, including a stomach ulcer or bleed.

The researchers matched each case with 10 control patients.

Prescriptions for anti-inflammatory drugs and aspirin issued in the 3 years before the study were identified for both cases and controls.

Of 9407 cases, the team noted that 45% had been prescribed a conventional non-steroidal anti-inflammatory drug in the previous 3 years.

Risks remained significantly increased for naproxen, diclofenac, and rofecoxib
British Medical Journal

The research team observed that 10% had been prescribed a COX-2 inhibitor.

Of 88,867 controls, 33% had been prescribed an non-steroidal anti-inflammatory drug and 6% had been prescribed a COX-2 inhibitor.

The researchers found that increased risks of adverse gastrointestinal events were associated with current use of COX-2 inhibitors.

An increased risk of adverse gastrointestinal events was also associated with conventional non-steroidal anti-inflammatory drugs.

Risks were reduced after adjusting for other factors.

The team noted that risk remained significantly increased for naproxen, diclofenac, and rofecoxib, but not for current use of celecoxib.

The researchers observed that the use of ulcer healing drugs reduced the risk with all groups of non-steroidal anti-inflammatory drugs.

However, the increased risk for diclofenac remained significant.

Dr Hippisley-Cox's team concluded, “Evidence of enhanced gastrointestinal safety with any of the new cyclo-oxygenase-2 inhibitors compared with non-selective non-steroidal anti-inflammatory drugs is lacking.”

“These results suggest that COX-2 inhibitors may not be as safe as originally thought.”

“However, a possible confounding effect cannot be ruled out.”

BMJ 2005: 331: 1310-12, Embargoed 00:01 on 02/12/2005,GMT
02 December 2005

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