Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study

MacDonald, Thomas M.; Morant, S. V.; Robinson, Geoffrey C.; Shield, M. J.; McGilchrist, Mark; Murray, Frank E.; McDevitt, D. G.

doi:10.1136/bmj.315.7119.1333

Cited by 274 publications

(164 citation statements)

References 21 publications

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“…[42][43][44] The first is a meta-analysis of case-control studies, the second is a cohort study of 130,000 patients over 50 years in the United Kingdom, and the third is a case-control study of 780,000 patients from Italy. These three studies give clear differences in gastrointestinal risks with the different tNSAIDs, and some compounds are clearly associated with higher risks of upper gastrointestinal bleeding than others ( lost once their dose is increased.…”

Section: Relative Risks For Gastrointestinal Toxicity Of the Differenmentioning

confidence: 99%

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

Ong¹,

Lirk²,

Tan³

et al. 2007

Clinical Medicine & Research

478

286

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Nonsteroidal anti-inflammatory drugs (NSAIDs), including both traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. NSAIDs are a necessary choice in pain management because of the integrated role of the COX pathway in the generation of inflammation and in the biochemical recognition of pain. This group of drugs has recently come under scrutiny because of recent focus in the literature on the various adverse effects that can occur when applying NSAIDs.This review will provide an educational update on the current evidence of the efficacy and adverse effects of NSAIDs. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are the effective therapeutic approaches that could reduce the adverse effects of NSAIDs. Finally, an algorithm is proposed which delineates a general decision-making tree to select the most appropriate analgesic for an individual patient based on the evidence reviewed. Keywords: Analgesics; COX-2 specific inhibitors; NSAIDs; Pain Nonst eroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications in the world because of their demonstrated efficacy in reducing pain and inflammation. 1 Their efficacy has been documented in a number of clinical disorders, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhea, dental pain and headache. [2][3][4][5][6][7][8] The basic mode of action is inhibition of the pro-inflammatory enzyme cyclooxygenase (COX). NSAIDs as a class comprise both traditional nonselective NSAIDs (tNSAIDs) that nonspecifically inhibit both COX-1 and COX-2, and selective COX-2 inhibitors. Although effective at relieving pain and inflammation, tNSAIDs are associated with a significant risk of serious gastrointestinal adverse events with chronic use. 9 Therefore, specific inhibitors of the COX-2 isoenzyme were developed, thus opening the possibility to provide antiinflammatory and analgesic benefits, while theoretically leaving the gastroprotective activity of the COX-1 isoenzyme intact. However, important concerns have recently been raised regarding the potential cardiovascular toxicity of COX-2 inhibitors. 10This review will provide an educational update of the scientific evidence for the efficacy and adverse effects of NSAIDs in view of the emerging new information for this class of drugs. It is composed deliberately to be a classic, pragmatic review and draws on the results of published systematic reviews and studies regarding the topic. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are...

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Section: Relative Risks For Gastrointestinal Toxicity Of the Differenmentioning

confidence: 99%

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

Ong¹,

Lirk²,

Tan³

et al. 2007

Clinical Medicine & Research

478

286

View full text Add to dashboard Cite

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“…[1][2][3][4][5] As reported in several studies, the risk attributable to NSAIDs may vary substantially based on the presence of one or more upper gastrointestinal risk factors. The most notable of these risk factors include advanced age, history of gastro-duodenal ulcers or ulcer complications, concomitant medications (corticosteroids, aspirin and anticoagulants), patient disability and history of upper gastrointestinal symptoms (e.g.…”

Section: Introductionmentioning

confidence: 99%

Adherence to proton pump inhibitors or H₂‐receptor antagonists during the use of non‐steroidal anti‐inflammatory drugs

Sturkenboom

Burke²,

Tangelder³

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: The efficacy of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H 2 RAs) prescribed as prophylaxis for NSAID-related upper gastrointestinal (UGI) toxicity is dependent upon patient adherence. Aim: To describe patient adherence to prophylactically prescribed PPIs and H 2 RAs in the clinical setting. Methods: We conducted a retrospective observational cohort study using the Integrated Primary Care Information Project database. The study population consisted of incident non-specific NSAID users prescribed a PPI or H 2 RA specifically as prophylaxis for NSAID-related UGI toxicity. Patients were classified as non-adherent if < 75% of days of NSAID use were covered by one of these agents, and as continuing users after discontinuation of NSAID use if they had a renewed prescription for these agents after their last NSAID prescription. Results: The study cohort comprised 784 patients: 374 with H 2 RAs, 405 with PPIs, and 5 with both PPI and

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“…184 This was not corrected for dose or baseline GI risk. When odds ratios are corrected for previous NSAID use, age and sex, the odds ratios compared with non-use for diclofenac and ibuprofen are 2.7 (95% CI 1.5 to 4.8) and 2.1 (95% CI 0.6 to 7.1), suggesting that there is no difference in the safety of these two NSAIDs.…”

mentioning

confidence: 99%

A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling

Brown¹,

Hooper²,

Elliott³

et al. 2006

Health Technol Assess

137

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Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study

Abstract: This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.

Cited by 274 publications

References 21 publications

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

Adherence to proton pump inhibitors or H₂‐receptor antagonists during the use of non‐steroidal anti‐inflammatory drugs

A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling

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Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study

Abstract: This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.

Cited by 274 publications

References 21 publications

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

Adherence to proton pump inhibitors or H2‐receptor antagonists during the use of non‐steroidal anti‐inflammatory drugs

A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling

Contact Info

Product

Resources

About

Adherence to proton pump inhibitors or H₂‐receptor antagonists during the use of non‐steroidal anti‐inflammatory drugs