A study, published in the BMJ, found no evidence to claims that the new generation of anti-inflammatory drugs ( COX-2 inhibitors ) are less harmful to the stomach lining than many traditional anti-inflammatory drugs.

These drugs were specifically designed to provide pain relief without the serious gastrointestinal side effects associated with the traditional non-steroidal anti-inflammatory drugs.

Researchers at the University of Nottingham identified patients from 367 UK general practices with a first ever diagnosis of an upper gastrointestinal event ( stomach ulcer or bleed ). Each case was matched with up to 10 control patients.

Prescriptions for anti-inflammatory drugs and Aspirin issued in the three years before the study were identified for both cases and controls.

Of 9407 cases, 45% had been prescribed a conventional non-steroidal anti-inflammatory drug ( NSAID ) in the previous three years and 10% had been prescribed a COX-2 inhibitor.
Of 88,867 controls, 33% had been prescribed an NSAID and 6% had been prescribed a COX-2 inhibitor.

Increased risks of adverse gastrointestinal events were associated with current use of COX-2 inhibitors and with conventional non-steroidal anti-inflammatory drugs.
Risks were reduced after adjusting for other factors, but remained significantly increased for Naproxen ( Aleve/Naprosyn ), Diclofenac ( Cataflam/Voltaren ), and Rofecoxib ( Vioxx ), but not for current use of Celecoxib ( Celebrex ).

The use of ulcer healing drugs reduced the risk with all groups of non-steroidal anti-inflammatory drugs, although for Diclofenac the increased risk remained significant.

Evidence of enhanced gastrointestinal safety with any of the new cyclo-oxygenase-2 inhibitors compared with non-selective non-steroidal anti-inflammatory drugs is lacking, say the authors.

These results suggest that COX-2 inhibitors may not be as safe as originally thought, although a possible confounding effect cannot be ruled out, they conclude.

Source: British Medical Journal, 2005


XagenaMedicine2005