Tips from Other Journals

Do COX-2 Inhibitors Cause Less Mucosal Damage than NSAIDs?

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2000 Jul 1;62(1):224.

The annual incidence of clinically important gastrointestinal complications resulting from therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) approaches 2 percent in patients with arthritis. Endoscopic studies of such patients suggest that the incidence of NSAID–induced gastroduodenal ulcers ranges from 15 to 30 percent. Cyclooxygenase-2 (COX-2) inhibitors appear to have fewer gastrointestinal side effects than NSAIDs. Hawkey and associates conducted a comparative study of the gastrointestinal effects of the COX-2 inhibitor rofecoxib, ibuprofen and placebo in patients with osteoarthritis.

The randomized double-blind study included 775 patients who were assigned to one of four treatment groups: 800 mg of ibuprofen three times daily (193 patients), 25 mg of rofecoxib daily (195 patients), 50 mg of rofecoxib daily (193 patients) and placebo (194 patients). The duration of therapy was 16 to 24 weeks. Baseline endoscopic examination was performed in all patients after they had discontinued their usual anti-inflammatory medications. They were reevaluated endoscopically at weeks 6, 12 and 24 of the study. The final outcome measure was the presence or absence of gastroduodenal ulcers at the 12th and 24th weeks of therapy.

Significantly fewer patients who received rofecoxib developed ulcers compared with those who received ibuprofen. The cumulative incidence of ulcers 3 mm or greater in size after 24 weeks of therapy was 9.9 percent in patients who received 25 mg of rofecoxib and 12.4 percent in those who received 50 mg of the COX-2 inhibitor. In contrast, in the ibuprofen group, the incidence of ulcers 3 mm or greater in size was 46.8 percent after 24 weeks of therapy. The incidence of ulcers in patients who received 25 mg of rofecoxib was comparable to that in the placebo group.

The authors conclude that rofecoxib in a dosage two to four times greater than the therapeutically effective dosage causes fewer ulcers than ibuprofen. The effects on the gastroduodenal mucosa of a daily dosage of 25 mg (the highest dosage recommended for treatment of osteoarthritis) were similar to those associated with placebo.

Hawkey C, et al. Comparison of the effect of rofecoxib (a cyclooxygenase 2 inhibitor), ibuprofen, and placebo on the gastroduodenal mucosa of patients with osteoarthritis. Arthritis Rheum. February 2000;43:370–7.



 

Copyright © 2000 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


MOST RECENT ISSUE


Sep 15, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article