Conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are effective anti-inflammatory and analgesic drugs, but their use is accompanied by an enhanced risk of upper gastrointestinal complications. The management of these events, which range from mild to potentially life-threatening, is an important and practical clinical issue.
Cyclooxygenase (COX) exists in two isoforms — COX-1 and COX-2. COX-1 is important for the protection of the gastric and duodenal mucosa, and the gastrointestinal toxicity resulting from nonselective NSAIDs is mediated by inhibition of COX-1. COX-2 is highly expressed at sites of inflammation, which has led to the development of selective COX-2 inhibitors (coxibs), which control pain and inflammation while sparing the protective effects of COX-1. Initial studies provided evidence of a reduced incidence of endoscopic ulcers and gastrointestinal bleeding with coxibs compared with conventional NSAIDs — a finding that has been confirmed subsequently in clinical outcome studies.
Prescribing practices are currently shifting with respect to patients requiring anti-inflammatory therapy. On the strength of the present evidence, several therapeutic approaches are available: the prescription of conventional NSAIDs, with the addition of a gastroprotective agent (GPA) when it is considered necessary based on the patient’s risk of having a gastrointestinal adverse event, or treatment with a coxib, with the addition of a GPA being an option in high-risk patients. You can start online shopping right now – buy birth control online for more advantages.
Data from outcome studies, plus evidence from current clinical practice, indicate that coxibs offer a clinical efficacy equivalent to that of conventional NSAIDs, with an improved gastrointestinal tolerability profile. Clear, evidence-based recommendations with respect to gastrointestinal safety issues are required to guide prescribing practices. This review presents therapeutic guidelines for physicians who prescribe anti-inflammatory agents, with a view to optimizing the cost effective use of currently available drugs.