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Systematic review with network meta-analysis: comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity.
Aliment Pharmacol Ther. 2016 06; 43(12):1262-75.AP

Abstract

BACKGROUND

Many strategies are used to prevent nonsteroidal anti-inflammatory drug (NSAID)-associated gastrointestinal toxicity, but the comparative effectiveness remains unclear.

AIM

To evaluate the comparative effectiveness of clinical strategies for preventing gastrointestinal toxicity induced by NSAIDs.

METHODS

MEDLINE, EMBASE and the Cochrane Library (from their inception to May 2015) were searched for randomised controlled trials comparing the risk of gastrointestinal adverse events in patients taking nonselective NSAIDs, selective cyclooxygenase(COX)-2 inhibitors or nonselective NSAIDs/COX-2 inhibitors plus gastroprotective agents [proton pump inhibitors (PPIs), histamine-2 receptor antagonists, misoprostol]. Both pairwise meta-analysis and Bayesian network meta-analysis were performed.

RESULTS

Analyses were based on 82 trials including 125 053 participants. Network meta-analysis demonstrated that selective COX-2 inhibitors + PPIs [Risk ratio (RR), 95% Credible Interval (CrI): ulcer complications 0.07, 0.02-0.18], selective COX-2 inhibitors (RR, 95% CrI: ulcer complications 0.25, 0.15- 0.38; symptomatic ulcer 0.12, 0.04-0.30), nonselective NSAIDs + PPIs (RR, 95% CrI: ulcer complications 0.28, 0.18-0.41; symptomatic ulcer 0.11, 0.04-0.23), nonselective NSAIDs + misoprostol (RR, 95% CrI: ulcer complications 0.47, 0.24-0.81; symptomatic ulcer 0.41, 0.13-1.00) were associated with significantly lower risk of clinical gastrointestinal events compared with nonselective NSAIDs. For all effectiveness endpoints, selective COX-2 inhibitors + PPIs was associated with the lowest absolute event probability and the highest rank, followed by selective COX-2 inhibitors and thirdly by nonselective NSAIDs + PPIs.

CONCLUSION

The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs.

Authors+Show Affiliations

School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, China.Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.Department of Gastroenterology, Peking University Shenzhen Hospital, Shenzhen, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China.Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27121479

Citation

Yuan, J Q., et al. "Systematic Review With Network Meta-analysis: Comparative Effectiveness and Safety of Strategies for Preventing NSAID-associated Gastrointestinal Toxicity." Alimentary Pharmacology & Therapeutics, vol. 43, no. 12, 2016, pp. 1262-75.
Yuan JQ, Tsoi KK, Yang M, et al. Systematic review with network meta-analysis: comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity. Aliment Pharmacol Ther. 2016;43(12):1262-75.
Yuan, J. Q., Tsoi, K. K., Yang, M., Wang, J. Y., Threapleton, D. E., Yang, Z. Y., Zou, B., Mao, C., Tang, J. L., & Chan, F. K. (2016). Systematic review with network meta-analysis: comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity. Alimentary Pharmacology & Therapeutics, 43(12), 1262-75. https://doi.org/10.1111/apt.13642
Yuan JQ, et al. Systematic Review With Network Meta-analysis: Comparative Effectiveness and Safety of Strategies for Preventing NSAID-associated Gastrointestinal Toxicity. Aliment Pharmacol Ther. 2016;43(12):1262-75. PubMed PMID: 27121479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review with network meta-analysis: comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity. AU - Yuan,J Q, AU - Tsoi,K K F, AU - Yang,M, AU - Wang,J Y, AU - Threapleton,D E, AU - Yang,Z Y, AU - Zou,B, AU - Mao,C, AU - Tang,J L, AU - Chan,F K L, Y1 - 2016/04/28/ PY - 2016/01/14/received PY - 2016/01/25/revised PY - 2016/03/18/revised PY - 2016/04/05/revised PY - 2016/04/07/revised PY - 2016/04/07/accepted PY - 2016/4/29/entrez PY - 2016/4/29/pubmed PY - 2017/8/16/medline SP - 1262 EP - 75 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 43 IS - 12 N2 - BACKGROUND: Many strategies are used to prevent nonsteroidal anti-inflammatory drug (NSAID)-associated gastrointestinal toxicity, but the comparative effectiveness remains unclear. AIM: To evaluate the comparative effectiveness of clinical strategies for preventing gastrointestinal toxicity induced by NSAIDs. METHODS: MEDLINE, EMBASE and the Cochrane Library (from their inception to May 2015) were searched for randomised controlled trials comparing the risk of gastrointestinal adverse events in patients taking nonselective NSAIDs, selective cyclooxygenase(COX)-2 inhibitors or nonselective NSAIDs/COX-2 inhibitors plus gastroprotective agents [proton pump inhibitors (PPIs), histamine-2 receptor antagonists, misoprostol]. Both pairwise meta-analysis and Bayesian network meta-analysis were performed. RESULTS: Analyses were based on 82 trials including 125 053 participants. Network meta-analysis demonstrated that selective COX-2 inhibitors + PPIs [Risk ratio (RR), 95% Credible Interval (CrI): ulcer complications 0.07, 0.02-0.18], selective COX-2 inhibitors (RR, 95% CrI: ulcer complications 0.25, 0.15- 0.38; symptomatic ulcer 0.12, 0.04-0.30), nonselective NSAIDs + PPIs (RR, 95% CrI: ulcer complications 0.28, 0.18-0.41; symptomatic ulcer 0.11, 0.04-0.23), nonselective NSAIDs + misoprostol (RR, 95% CrI: ulcer complications 0.47, 0.24-0.81; symptomatic ulcer 0.41, 0.13-1.00) were associated with significantly lower risk of clinical gastrointestinal events compared with nonselective NSAIDs. For all effectiveness endpoints, selective COX-2 inhibitors + PPIs was associated with the lowest absolute event probability and the highest rank, followed by selective COX-2 inhibitors and thirdly by nonselective NSAIDs + PPIs. CONCLUSION: The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/27121479/Systematic_review_with_network_meta_analysis:_comparative_effectiveness_and_safety_of_strategies_for_preventing_NSAID_associated_gastrointestinal_toxicity_ L2 - https://doi.org/10.1111/apt.13642 DB - PRIME DP - Unbound Medicine ER -