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NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective.
Clin Exp Rheumatol. 2001 Nov-Dec; 19(6 Suppl 25):S23-30.CE

Abstract

Many studies have shown that a variety of strategies, including the use of cyclooxygenase-2 (COX-2) inhibitors, or co-prescription of misoprostol or proton pump inhibitors, result in reduced endoscopic damage and ulceration compared with non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Questions have been raised as to whether this would translate into improved clinical outcomes. Consequently, several studies have investigated whether use of COX-2 inhibitors (Vioxx Gastrointestinal Outcomes Research [VIGOR] and the Celecoxib Long-Term Arthritis Safety Assessment Study [CLASS] studies) or co-prescription with misoprostol (MUCOSA) would reduce the event rate of clinically significant ulcers. These studies have shown an approximate halving of such events. They have raised the possibility that use of low dose aspirin may compromise these benefits and appear to have shown differences between (at least some) COX-2 inhibitors and (at least some) NSAIDs with regard to myocardial infarction. Among the lessons learned from this experience are the need to define closely the outcomes of interest and possibly to concentrate on ulcer complications, the need for adequately powered studies, and the fact that endoscopic studies broadly predict outcomes. However, there are differences in the estimated rates of reduction. It is not self evident whether outcomes studies or endoscopic studies give a truer estimate of risk. A helpful development would be more standardized gastrointestinal assessment at the time of ulcer complications and this could be achieved if studies were done in countries with well-developed primary care systems.

Authors+Show Affiliations

Division of Gastroenterology, University Hospital Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

11695247

Citation

Hawkey, C J.. "NSAIDs and COX-2 Inhibitors: what Can We Learn From Large Outcomes Trials? the Gastroenterologist's Perspective." Clinical and Experimental Rheumatology, vol. 19, no. 6 Suppl 25, 2001, pp. S23-30.
Hawkey CJ. NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective. Clin Exp Rheumatol. 2001;19(6 Suppl 25):S23-30.
Hawkey, C. J. (2001). NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective. Clinical and Experimental Rheumatology, 19(6 Suppl 25), S23-30.
Hawkey CJ. NSAIDs and COX-2 Inhibitors: what Can We Learn From Large Outcomes Trials? the Gastroenterologist's Perspective. Clin Exp Rheumatol. 2001 Nov-Dec;19(6 Suppl 25):S23-30. PubMed PMID: 11695247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective. A1 - Hawkey,C J, PY - 2001/11/7/pubmed PY - 2002/3/8/medline PY - 2001/11/7/entrez SP - S23 EP - 30 JF - Clinical and experimental rheumatology JO - Clin Exp Rheumatol VL - 19 IS - 6 Suppl 25 N2 - Many studies have shown that a variety of strategies, including the use of cyclooxygenase-2 (COX-2) inhibitors, or co-prescription of misoprostol or proton pump inhibitors, result in reduced endoscopic damage and ulceration compared with non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Questions have been raised as to whether this would translate into improved clinical outcomes. Consequently, several studies have investigated whether use of COX-2 inhibitors (Vioxx Gastrointestinal Outcomes Research [VIGOR] and the Celecoxib Long-Term Arthritis Safety Assessment Study [CLASS] studies) or co-prescription with misoprostol (MUCOSA) would reduce the event rate of clinically significant ulcers. These studies have shown an approximate halving of such events. They have raised the possibility that use of low dose aspirin may compromise these benefits and appear to have shown differences between (at least some) COX-2 inhibitors and (at least some) NSAIDs with regard to myocardial infarction. Among the lessons learned from this experience are the need to define closely the outcomes of interest and possibly to concentrate on ulcer complications, the need for adequately powered studies, and the fact that endoscopic studies broadly predict outcomes. However, there are differences in the estimated rates of reduction. It is not self evident whether outcomes studies or endoscopic studies give a truer estimate of risk. A helpful development would be more standardized gastrointestinal assessment at the time of ulcer complications and this could be achieved if studies were done in countries with well-developed primary care systems. SN - 0392-856X UR - https://www.unboundmedicine.com/medline/citation/11695247/NSAIDs_and_COX_2_inhibitors:_what_can_we_learn_from_large_outcomes_trials_The_gastroenterologist's_perspective_ L2 - https://antibodies.cancer.gov/detail/CPTC-PTGS2-1 DB - PRIME DP - Unbound Medicine ER -