FIRST AUSTRALIAN STUDY SHOWS BENEFITS OF COX-2s IN REDUCING UPPER GASTRO-INTESTINAL HOSPITAL ADMISSIONS

A dramatic drop in the rate of hospitalisation due to gastrointestinal complications of traditional arthritis drugs can be linked to the use of newer arthritis medications, a leading gastroenterologist said today.

Professor Graeme Young, Professor of Gastroenterology at Flinders Medical Centre, Adelaide said the first Australian study to review national hospitalisation data for serious gastrointestinal bleeding showed a reduction by nearly one third of hospitalisations linked to gastrointestinal complications.1″This data confirms the benefits of the newer arthritis medications, known as COX-2 specific agents, compared with the traditional NSAIDs in terms of gastrointestinal safety,” Professor Young said.The study will be presented at the Australian Gastroenterology Week conference in Brisbane this weekend (October 22).Professor Young said that clinical studies had shown there was significantly less gastrointestinal toxicity associated with the COX-2s,2 and the findings of this study supported this at a population level in Australia.”The study backs up what gastroenterologists are seeing in their daily practice – that there appears to be fewer patients with gastric ulcers due to NSAIDs,” he said.The COX-2 specific medications are a class of highly targeted arthritis drugs that have a lower risk of gastrointestinal side effects than the traditional NSAIDs.2It is estimated that there are 4500 hospital admissions each year for serious upper gastrointestinal adverse effects of NSAIDs. It is expected that 10% of these individuals will die, that is between 200 and 400 deaths per annum.3This is on a par with asthma deaths in Australia which were 397 in 2002.4 The study involved an analysis of monthly hospital admissions for upper gastrointestinal events between July 1998 and June 2002 from the Australian Institute of Health and Welfare. Prescription data were also obtained for the same period for COX-2 specific medications, NSAIDs and anti-ulcer medications – proton pump inhibitors and H2 receptor antagonists. Based on the findings of this study, Professor Young and his team are now analysing hospital admissions data to determine whether there has been any increase in major gastrointestinal events in the wake of the withdrawal from the market of the COX-2 agent Vioxx.”This withdrawal resulted in a return to the traditional NSAIDs, which may then have had a corresponding impact on hospital admissions for severe gastrointestinal side affects in patients intolerant of these agents,” he said.The study findings being presented by Professor Young this weekend compared the period before the introduction of the COX-2s (1998-1999) with the period after their introduction (2001-2002).After the impact of the anti-ulcer medications was taken into account, the analysis showed a reduction in hospitalisation for severe gastrointestinal events of nearly one third (28.9 per cent) when comparing the period before the introduction of the COX-2s with the period after they became available.”The 30 per cent drop in the rate of hospitalisation may not be completely due to the switch to the COX-2s, but they will have certainly played a major role in this decline,” Professor Young said.”These results provide population confirmation of results of previous clinical trials and other research that show the improved gastrointestinal safety of COX-2s compared with non-selective NSAIDs.””What this means to arthritis patients is that many who could not tolerate the traditional NSAIDs can get symptom relief with the COX-2 medications which carry significantly less risk of adverse gastrointestinal side effects.””This study suggests that people who take the COX-2s will have a reduced risk of hospitalisation related to complicated peptic ulcer disease.”References:1. Young GP et al. Association Between Introduction of Coxibs and Reduced Upper GI Hospitalisations in Australia. Abstract. UEGW, September 2004.2. Mamdani M et al. Observational study of upper GI haemorrhage in elderly patients given selective COX-2 inhibitors or conventional NSAID drugs BMJ 2002;325:624-627.3. Day RO et al. Towards the safer use of non-steroidal anti-inflammatory drugs. J Qual Clin Practice 1999;19:51-53.4. National Asthma Council Australia. http://www.nationalasthma.org.au/