Abstract
Gastrointestinal complications from the use of nonsteroidal antiinflammatory drugs (NSAIDs) are common and costly. Cyclooxygenase (COX)-2 inhibitors cause fewer gastrointestinal events than nonselective NSAIDs but may still result in peptic ulcer complications in a significant proportion of high-risk patients. The risk can be further reduced by prescribing COX-2 inhibitors together with proton pump inhibitors. Small-bowel injury is also commonly seen in long-term users of COX-2 inhibitors. The potential cardiovascular side effects of most COX-2 inhibitors and NSAIDs pose great challenge to physicians. Further studies are required to optimize the treatment regimen in patients with high cardiovascular and gastrointestinal risk and to decide the best treatment options for patients with small- and large-bowel complications.
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References
Laine L. Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 2001;120:594–606.
Talley NJ, Evans JM, Fleming KC, Harmsen WS, Zinsmeister AR, Melton LJ III. Nonsteroidal antiinflammatory drugs and dyspepsia in the elderly. Dig Dis Sci 1995;40:1345–1350.
Langman MJ. Ulcer complications associated with antiinflammatory drug use. What is the extent of the disease burden? Pharmacoepidemiol Drug Saf 2001;10:13–19.
Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study. A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000;284:1247–1255.
Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000;343:1520–1528.
Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP. Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Lancet 2007;369:465–473.
Rostom A, Muir K, Dube C, Jolicoeur E, Boucher M, Joyce J, et al. Gastrointestinal safety of cyclooxygenase-2 inhibitors: a Cochrane Collaboration systematic review. Clin Gastroenterol Hepatol 2007;5:818–28, 828 e811–815; quiz 768.
Targownik LE, Metge CJ, Leung S, Chateau DG. The relative efficacies of gastroprotective strategies in chronic users of nonsteroidal anti-inflammatory drugs. Gastroenterology 2008;134:937–944.
Graham DY, Chan FK. NSAIDs, risks, and gastroprotective strategies: current status and future. Gastroenterology 2008;134:1240–1246.
Chan FK, Hung LC, Suen BY, Wu JC, Lee KC, Leung VK, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 2002;347:2104–2110.
Chan FK, Hung LC, Suen BY, Wong VW, Hui AJ, Wu JC, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology 2004;127:1038–1043.
Chan FK, Wong VW, Suen BY, Wu JC, Ching JY, Hung LC, et al. Combination of a cyclo-oxygenase-2 inhibitor and a protonpump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 2007;369:1621–1626.
Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Zlotnick S, Fort JG. Video capsule endoscopy to prospectively assess smallbowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 2005;3:133–141.
Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Aisenberg J, Bhadra P, et al. Small-bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 2007;25:1211–1222.
Maiden L, Thjodleifsson B, Seigal A, Bjarnason II, Scott D, Birgisson S, Bjarnason I. Long-term effects of nonsteroidal antiinflammatory drugs and cyclooxygenase-2 selective agents on the small bowel: a cross-sectional capsule enteroscopy study. Clin Gastroenterol Hepatol 2007;5:1040–1045.
Juni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative metaanalysis. Lancet 2004;364:2021–2029.
Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005;352:1092–1102.
Solomon SD, McMurray JJ, Pfeffer MA, Wittes J, Fowler R, Finn P, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med 2005;352:1071–1080.
Cannon CP, Curtis SP, FitzGerald GA, Krum H, Kaur A, Bolognese JA, et al. Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Longterm (MEDAL) programme: a randomised comparison. Lancet 2006;368:1771–1781.
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Wong, V.WS., Chan, F.KL. Cyclooxygenase-2 inhibitors in patients with high gastrointestinal risk: are we there yet?. J Gastroenterol 44 (Suppl 19), 53–56 (2009). https://doi.org/10.1007/s00535-008-2260-z
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DOI: https://doi.org/10.1007/s00535-008-2260-z