Selective Cox-2 Inhibitors Effectively Lower GI Events at Population Level

One of the most dreaded adverse events associated with the long-term use of NSAIDs is a gastrointestinal bleed. As highlighted recently in a presentation by Professor Graham Young, prior to the introduction of selective NSAIDs, there were up to 4,000 hospital admissions directly related to NSAID use each year. Despite this, they remain very useful agents in pain control and symptom relief – especially for chronic musculoskeletal problems such as arthritis.

This prompted the creation of selective COX-2 inhibitors, which theoretically reduce inflammation and pain while maintaining the prostaglandin’s protective effects on the stomach. There is now much research into the use of these agents and the impact they have made on GI bleeding. In one study comparing ‘coxibs’ (such as celecoxib, or Celebrex) to non-selective NSAIDs, it was shown that GI bleeding was reduced by around 50%. This result has been confirmed by a recent study in the American Journal of Medicine, in which celecoxib was compared to non-selective agents such as diclofenac and naproxen. The selective agents were found to be equally effective for treating symptoms of osteoarthritis, and induced a statistically significant reduction in GI events.This evidence can be taken in light of broader statistics that show a steady reduction in the number of GI events between 1998 and 2002. This can be attributed to the introduction of selective agents, but also to the increased use of proton-pump inhibitors.Professor Young concludes that the ‘coxibs’ are associated with an improved gastrointestinal safety profile relative to non-selective NSAIDs. This is great news for patients, as there appears to be no difference in the efficacy of pain relief, allowing for equal effectiveness with a reduced chance of dangerous GI events.

Click here to watch a presentation by Dr Young on the benefits of COX-2 inhibitors over non-selective NSAIDs.

References:

1. Mamdani M, Rochon PA, Juurlink DN, Kopp A, Anderson GN, Naglie G, et al. Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs. BMJ 2002; 325: 624-7.
2. Singh G, Fort JG, Goldstein JL, Levy R, Hanrahan P, Bello A, et al. Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-I study. Am J Med 2006; 119: 255-66.