HOME
Return to Table of Contents
128 THE GASTROINTESTINAL TOXICITY OF CYCLOOXYGENASE-2 INHIBITORS: A COCHRANE COLLABORATION SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS A Rostom1, K Muir, C Dubé2, E Jolicoeur1, M Boucher3, J Joyce3, P Tugwell2 , GW Wells2 BACKGROUND AND AIMS: Traditional NSAIDs and COX-2 inhs are used to treat a variety of arthritic and inflammatory conditions. The aim of this study was to assess the upper GI harms of COX-2 inhs compared to that of non-selective NSAIDs and to placebo.
1University of Calgary, Calgary, Alberta; 2University of Ottawa; 3Canadian Coordinating Office of Health Technology Assessment, Ottawa, Ontario
METHODS: A systematic review of randomized controlled trials (RCTs) was conducted. Searches were conducted in: i) CENTRAL, ii) the Cochrane Collaboration Library (2005), iii) MEDLINE (to June 2005), and iv) EMBASE (to June 2005). Reference lists from trials, and abstracts of conference proceedings were handsearched, and experts were contacted to identify further relevant trials. RCTs of celecoxib, rofecoxib, meloxicam, etoricoxib, valdecoxib and lumiracoxib were included if they reported on endoscopic ulcers, clinically important ulcer complications or symptoms with the use of these COX-2 inhs, compared to placebo or to traditional NSAIDs. Study selection and data extraction were performed in duplicate by independent reviewers. Data were analyzed using Review Manager 4.2 in accordance with accepted meta-analysis techniques.
RESULTS: Compared with non-selective NSAIDs, COX-2 selective NSAIDs produced significantly fewer gastroduodenal ulcers (RR=0.26; 95% CI: 0.23 to 0.30) and clinically important ulcer complications (RR= 0.39; 95% CI: 0.31 to 0.50), as well as fewer treatment withdrawals due to GI symptoms. The co-administration of acetylsalicylic acid (ASA) diminished the benefit of COX-2 inhs when compared with non-selective NSAIDs.
CONCLUSIONS: COX-2 inhs NSAIDs appear to offer greater upper GI safety and are better tolerated than non-selective NSAIDs in general. The co-administration of ASA appears to negate the safety advantage of COX-2 inhs over that of traditional NSAIDs.