Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: CLINICAL EXPERIENCE WITH COXIBS Part 1

Endoscopic studies

Endoscopic studiesTwo randomized, placebo controlled trials have demonstrated a significantly lower incidence of ulcers with rofe-coxib treatment than with ibuprofen treatment. In one study, the rate of gastric and/or duodenal ulcers at 12 weeks was significantly lower in patients treated with rofe-coxib 25 mg or placebo (4.1% versus 9.9%) than in those treated with ibuprofen 800 mg tid (27.7%, P<0.001). Similarly low ulcer rates were reported in a second study comparing rofecoxib 25 mg with ibuprofen 800 mg tid (5.3% versus 29.2%, P<0.001). In both studies, this reduced incidence of ulcers with the use of rofecoxib compared with ibuprofen was maintained at six months.

The use of celecoxib 200 mg to 800 mg daily is also associated with a low rate of endoscopically defined ulcers, which is similar to that of placebo (6% versus 4%) and significantly lower than that of naproxen (26%, P<0.01).

Outcome studies

Outcome studies have been conducted to investigate whether the favourable endoscopic findings reported with the coxibs translate into a similar decrease in the incidence of clinically significant gastrointestinal events. Fast and reliable shopping for drugs – buy cipro to get safe shopping atmosphere.

The VIGOR study investigated, over one year, the upper gastrointestinal toxicity of rofecoxib 50 mg daily compared with naproxen 1000 mg daily in more than 8000 patients with rheumatoid arthritis. The incidence of confirmed upper gastrointestinal events, over the study period of treatment, was significantly lower with rofecoxib 50 mg daily than with naproxen 1000 mg daily (1.4% versus 3.0%, relative risk 0.5; P<0.001). A significantly lower incidence of confirmed complicated upper gastrointestinal events was reported with rofecoxib than with naproxen (0.4% versus 0.9%, relative risk 0.4; P=0.005). This incidence of confirmed complicated upper gastrointestinal events translates into an annualized rate of 0.6%, and 1% to 4% per 100 patient-years, respectively.

This entry was posted in Coxibs and tagged Coxibs, Cyclooxygenase-2 inhibitors, Gastroprotective agents, Nonsteroidal anti-inflammatory drugs.