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Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: a systematic review and meta-analysis

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Abstract

Background

There are conflicting and inconsistent data regarding the gastrointestinal (GI) protective effect of cyclooxygenase-2 (COX-2) inhibitors and of non-steroidal anti-inflammatory drugs (NSAIDs) plus proton-pump inhibitors (PPI).

Aim

To compare the adverse GI effects between COX-2 inhibitors and NSAIDs plus PPI.

Methods

We performed a systematic review of randomized trials comparing GI adverse effects between COX-2 inhibitors and NSAID plus PPI. Trials were identified in MEDLINE, EMBASE, and the Cochrane Library. Primary outcomes were major GI complications including hemorrhage, perforation, and obstruction.

Results

A total of nine trials involving 7,616 participants from 2002 to 2011 were included. All trials were randomized, double blinded, and placebo-controlled with moderate to high quality. COX-2 inhibitors were found to have significantly reduced the risk of major GI events, including perforation, obstruction, and bleeding (relative risk or RR 0.38, 95 % confidence interval or CI 0.25–0.56, p < 0.001); however, the benefit was significant only for patients who were at high risk for NSAID-related GI complications and long-term users. Additionally, the risk of diarrhea (RR 0.56, 95 % CI 0.35–0.9, p 0.02) and withdrawal (RR 0.77, 95 % CI 0.62–0.94, p 0.01) was significantly lower in use of COX-2 inhibitors, while the rate of dyspepsia was higher (RR 1.58, 95 % CI 1.26–1.98, p < 0.001).

Conclusions

COX-2 inhibitors significantly reduced the risk of perforation, obstruction, bleeding, diarrhea, and withdrawal due to GI adverse events, while the risk of dyspepsia was lower with NSAIDs plus PPI.

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The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine, Nakornprathom Hospital, Nakornprathom, Thailand

    Saharat Jarupongprapa

  2. Division of Rheumatology, Department of Medicine Siriraj Hospital, Mahidol University, 8th Floor, Asadang Building, Prannok Road, Bangkok-noi, Bangkok, 10700, Thailand

    Prapassorn Ussavasodhi & Wanruchada Katchamart

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  1. Saharat Jarupongprapa
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  2. Prapassorn Ussavasodhi
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  3. Wanruchada Katchamart
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Correspondence to Wanruchada Katchamart.

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Jarupongprapa, S., Ussavasodhi, P. & Katchamart, W. Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: a systematic review and meta-analysis. J Gastroenterol 48, 830–838 (2013). https://doi.org/10.1007/s00535-012-0717-6

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  • DOI: https://doi.org/10.1007/s00535-012-0717-6

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