Gastroduodenal 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 32004000199
English, French
Authors' objectives:
The aims of this study were: 1. To assess how well gastroprotective agents protect against the upper gastrointestinal (GI) damage caused by traditional non-selective non-steroidal anti-inflammatory drugs (NSAIDs).
2. To compare the upper GI damage caused by cyclooxygenase (COX)-2 selective NSAIDs with that caused by traditional non-selective NSAIDs.
3. To compare the upper GI damage caused by COX-2 selective NSAIDs with that caused by placebo.
Authors' recommendations:
Gastroprotective agents: - Misoprostol, PPIs and double doses of H2RAs are effective at reducing the risk of endoscopically identified NSAID-induced ulcers.
- Standard doses of H2RAs are ineffective at reducing the risk of endoscopically identified NSAID-induced ulcers.
- Misoprostol is the only agent that has been shown to reduce the risk of NSAID-induced clinically important ulcer complications. Its use, however, is associated with significant adverse effects, particularly at higher doses.
COX-2 selective NSAIDs: - COX-2 selective NSAIDs are associated with a lower risk of endoscopically identified ulcers and of clinically important ulcer complications when compared with traditional non-selective NSAIDs in general.
- COX-2 selective NSAIDs were found to be safer than naproxen and ibuprofen (high dose), but no significant difference was found between the COX-2 selective NSAIDs reviewed and diclofenac.
- Preliminary results indicate that the reduced GI complication rate due to celecoxib may be lost when it is administered with acetylsalicylic acid (ASA). This has not been tested for rofecoxib.
- Meloxicam does not seem to be safer than traditional non-selective NSAIDs. It is unclear whether the co-administration of a COX-2 selective NSAID and a gastroprotective agent significantly improves safety over the use of a COX-2 selective NSAID alone or the use of a traditional nonselective NSAID with gastroprotection.
Authors' methods:
Systematic review
Details
Project Status:
Completed
URL for project:
https://www.ccohta.ca/
Year Published:
2004
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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