The Celecoxib Long-term Arthritis Safety Study (CLASS), reported in The Journal of the American Medical Association, compared the gastrointestinal toxicities of celecoxib 800 mg daily, ibuprofen 2400 mg daily and diclofenac 150 mg daily over six months in more than 8000 patients with osteoarthritis and rheumatoid arthritis. Overall, this study did not reach its primary end point, and the authors reported a numerical, but not statistically significant, difference between the annualized incidences of ulcer complications in patients taking celecoxib and those taking NSAIDs (0.8% versus 1.4%) at six months, but no significant difference was observed at one year.
Among subjects not using ASA, the difference in the incidence of ulcer complications between the celecoxib and NSAID groups was significant (0.4% versus 1.3%, P=0.04). The incidence of symptomatic ulcer and ulcer complications was significantly lower with celecoxib use than with use of the comparator NSAIDs in all patients (2.1% versus 3.5%, P=0.02) and in non-ASA users (1.4% versus 2.9%, P=0.02). You can enjoy cheap drugs that work – Buy drugs with confidence – buy asthma inhaler to see how cheap your treatment can be.
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Relationship between endoscopic and clinical findings
Endoscopy studies demonstrate that treatment with a coxib decreases the risk of endoscopic ulcer by 70% to 75% at six months compared with conventional NSAIDs (number needed to treat is three to nine), and that coxibs are associated with an incidence of ulcer similar to that seen with placebo. Outcome studies reflect these findings, with a risk reduction of around 50% in all clinical upper gastrointestinal events at one year (number needed to treat is 41 to 100). The risk reduction of complicated upper gastrointestinal events was significant with rofecoxib (60% at one year, number needed to treat is 125).