Cox-II inhibitors versus non-steroidal anti-inflammatory drugs in rheumatoid and osteoarthritis patients: gastrointestinal effects
de Vries C
Record ID 32004000040
English
Authors' objectives:
This study aims to assess the effects of cox-II inhibitors versus NSAIDs on risk of gastrointestinal adverse effects in people with rheumatoid arthritis or osteoarthritis.
Authors' recommendations:
Identified studies suggest that cox-II inhibitors are associated with a slightly reduced risk of gastrointestinal adverse events compared with NSAIDs. However, the reliability of the conclusion is limited by low power for detecting adverse effects. In many cases, adequate power was achieved by pooling results from different exposure groups (receiving different NSAIDs or different doses). This prevents direct comparison of adverse effects of particular cox-II inhibitors versus particular NSAIDs. Results may not be applicable to people at high risk of gastrointestinal adverse effects. Most studies excluded people with a recent history of serious gastrointestinal disease. Similarly, we found insufficient evidence to compare gastrointestinal adverse effects of cox-II inhibitors versus NSAIDs in high-risk patients such as those chronically using corticosteroids or those of older age. Concomitant use of H2-antagonists and/or proton pump inhibitors was not reported (in the NICE review) or not allowed (in the subsequent RCTs). We cannot, therefore, reliably answer the clinically important question of whether cox-II inhibitors reduce gastrointestinal adverse effects compared with combined therapy with NSAIDs plus H2 antagonists or proton pump inhibitors.
Authors' methods:
Review
Details
Project Status:
Completed
URL for project:
http://www.wihrd.soton.ac.uk
Year Published:
2002
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
England
MeSH Terms
- Anti-Inflammatory Agents, Non-Steroidal
- Arthritis, Rheumatoid
- Cyclooxygenase Inhibitors
- Osteoarthritis
Contact
Organisation Name:
Wessex Institute for Health Research and Development
Contact Address:
Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662
Copyright:
Bazian Ltd, Wessex Institute for Health Research and Development
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