Do proton‐pump inhibitors confer additional gastrointestinal protection in patients given celecoxib?

Rahme, Elham; Barkun, Alan N.; Toubouti, Youssef; Scalera, Alissa; Rochon, Sophie; LeLorier, Jacques

doi:10.1002/art.22764

Cited by 48 publications

(26 citation statements)

References 25 publications

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“…It is presumed but not proven that the combination of a PPI plus coxib may be safest from a GI standpoint. • An observational study suggests an additional 25% risk reduction in patients who use PPI plus celecoxib when compared with patients taking celecoxib alone [44]. • This combination is cost effective [31], providing an additional 50% reduction in the incidence of upper GI complications compared with competing strategies such as coxib alone or NSAID plus PPI.…”

Section: Combination Of Both Strategies: Coxibs Plus Ppimentioning

confidence: 98%

Prevention and treatment of NSAID-induced gastroduodenal injury

Lanas

2006

Curr Treat Options Gastro

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NSAIDs increase the risk of gastrointestinal (GI) complications. Those at risk should be considered for alternatives to NSAID therapy, modifications of risk factors, and prevention strategies with co-therapy with gastroprotective agents (proton-pump inhibitors or misoprostol) or COX-2 selective inhibitors (coxibs). Since coxibs, and probably other nonselective NSAIDs, may increase the risk of cardiovascular events, prevention strategies must take into account both GI and cardiovascular risk factors. All NSAIDs and coxibs should be prescribed at the lowest possible dose and for the shortest period of time. In patients with GI risk factors but no cardiovascular risk, coxibs or NSAIDs plus PPI or misoprostol are valid options. Patients with a history of ulcer bleeding should receive coxib plus PPI therapy and should be tested and treated for Helicobacter pylori infection. Most patients with increased cardiovascular risk will be treated with antiplatelet agents. It is not known whether co-therapy with low-dose aspirin will reduce the incidence of cardiovascular events, but it will further increase GI risk. It is currently unclear whether the risk of developing upper GI events with coxib plus aspirin is lower than it is with NSAIDs plus aspirin. However, all these patients should benefit from PPI co-therapy. Helicobacter pylori eradication should be considered as an additional therapeutic option when we want to further reduce the GI risk in specific patients. When the lower GI tract is of concern, coxib rather than NSAID therapy should be considered as the first option. Coxib therapy has better GI tolerance than NSAIDs, but patients with peptic ulcers or dyspepsia during NSAID/coxib treatment need PPI co-therapy.

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Section: Combination Of Both Strategies: Coxibs Plus Ppimentioning

confidence: 98%

Prevention and treatment of NSAID-induced gastroduodenal injury

Lanas

2006

Curr Treat Options Gastro

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“…13 This observation was confirmed in an observational case-control study, using a population-based claims-database in Canada, in which both gastroprotective strategies were similarly effective in the prevention of NSAID-related UGI events, but it did not address the lack of adherence to PPIs. 14 However, we and others have demonstrated that in real life, GPA adherence during nsNSAID use is an important factor to consider when evaluating and comparing the effectiveness of different gastroprotective strategies.…”

Section: Introductionmentioning

confidence: 91%

1038 Cyclo-Oxygenase-2 Inhibitors or Nonselective NSAIDs Plus Gastroprotective Agents: What to Prescribe in Daily Clinical Practice?

Masclee¹,

Valkhoff²,

Soest³

et al. 2013

Gastroenterology

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“…Based on gastrointestinal endoscopy data [21], COX-2-selective agents likely are safer options at all levels of risk compared with nonselective NSAIDs; however, due to issues of cost compared with generic nonselective NSAIDs, their use has been promoted primarily in patients at higher gastrointestinal risk (eg, two or more identified gastrointestinal risk factors). Recent data also have confirmed that a further reduction in gastrointestinal bleeding risk can be achieved in high-risk patients older than 70 years of age who require anti-inflammatory drugs by adding a PPI to a COX-2-selective inhibitor [22].…”

Section: Introductionmentioning

confidence: 94%

An update on nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors

Williams

2005

Current Science Inc

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Selective inhibitors of the cyclooxygenase-2 enzyme were developed to treat pain and inflammation while reducing the risk of the serious gastrointestinal side effects seen with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). The results of several clinical trials have demonstrated an apparent increased risk of serious cardiovascular events in patients taking the COX-2-selective inhibitors. Although the risk was observed originally with trials conducted with rofecoxib, it was attributed generally to the entire class of COX-2-selective drugs based on a similar mechanism of action and a hypothesis that predicted the possibility of a prothrombotic effect of the drugs compared with nonselective NSAIDs. Subsequent studies have demonstrated that elevated cardiovascular risk is not limited to the use of COX-2-specific inhibitors. An increase in cardiovascular risk actually has been seen with anti-inflammatory drugs of the NSAID class, regardless of whether they are selective or nonselective inhibitors. The US Food and Drug Administration has recommended that all such drugs carry a black box warning for gastrointestinal and cardiovascular risks.

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Do proton‐pump inhibitors confer additional gastrointestinal protection in patients given celecoxib?

Cited by 48 publications

References 25 publications

Prevention and treatment of NSAID-induced gastroduodenal injury

Prevention and treatment of NSAID-induced gastroduodenal injury

1038 Cyclo-Oxygenase-2 Inhibitors or Nonselective NSAIDs Plus Gastroprotective Agents: What to Prescribe in Daily Clinical Practice?

An update on nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors

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