Gastro-duodenal ulcers associated with the use of non-steroidal anti-inflammatory drugs: a systematic review of preventive pharmacological interventions
Rostom A, Dube C, Jolicoeur E, Boucher M, Joyce J
Record ID 32003001202
English, French
Authors' objectives:
To assess the effectiveness of common pharmacological interventions used to prevent upper gastrointestinal (GI) toxicity associated with non-selective non-steroidal anti-inflammatory drugs (NSAIDs).
To compare the upper GI toxicity of cyclooxygenase-isoform type 2 (COX-2) selective NSAIDs with that of non-selective NSAIDs, with or without concomitant use of gastroprotective agents.
To compare with placebo the upper GI toxicity of the COX-2 selective NSAIDs available in Canada.
Authors' recommendations:
Misoprostol, proton pump inhibitors, and double doses of histamine type-2 receptor antagonists (H2RAs) were shown to effectively reduce the risk of endoscopically identified NSAID-induced gastric and duodenal ulcers. Standard doses of H2RAs, however, are ineffective. Misoprostol is the only prophylactic agent that has been rigorously evaluated. While misoprostol reduces the risk of NSAID-related ulcer complications, its use is associated with significant adverse effects, particularly at higher doses.
Compared with most non-selective NSAIDs, COX-2 selective NSAIDs have a safer GI profile than other NSAIDs and are better tolerated. An exception is the comparator NSAID diclofenac: no statistically significant differences are observed for this agent. The reduced GI complication rate due to celecoxib may be lost when it is administered with acetylsalicyclic acid; this effect has not been tested with rofecoxib. The benefit of the growing clinical use of COX-2 selective NSAIDs with added gastroprotective agents remains untested.
Authors' methods:
Systematic review
Details
Project Status:
Completed
URL for project:
https://www.ccohta.ca/
Year Published:
2003
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Anti-Inflammatory Agents, Non-Steroidal
- Peptic Ulcer
Contact
Organisation Name:
Canadian Coordinating Office for Health Technology Assessment
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
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