Home > published mauscripts of interest > Dutch study suggests that COX-2 inhibiting NSAIDs should also always be prescribed with gastroprotective drugs

Dutch study suggests that COX-2 inhibiting NSAIDs should also always be prescribed with gastroprotective drugs

In clinical practice conventional (classic) NSAIDs are usually prescribed together with proton-pump-inhibtors (PPI) as concomitant gastroprotective agent (GPA). In patients not at risk for gstro-intestinal problems the COX-2 inhibtors group within the NSAIDs are not necessarily prescribed with concomitant GPA. I.e. when the COX-2 blocking agents were introduced, the reduced risk for gastro-intestinal bleedings was an important factor for drug registration by the authorities as well as in marketing for the pharmaceutical companies. However, from the classic NSAIDs the risk of gastrointestinal bleeding is well known as side-effect, especially when not (continuously) taking PPI. For the COX-2 inhibitors data on gastrointestinal complications when not or not continuously taking PPI were relatively lacking. A Dutch study was performed (and published today in Arthritis and Rheumatism) on the effect of adherence to a gastroprotective drug regimen with COX-2 blocker use. The investigatrs concluded that BOTH for classic NSAIDs as well as for COX-2 blockers the risk of developing gastrointetinal complications rises remarkably when PPIs are not taken as concomitant medication on a daily base.

Further analysis found that for every 10% decrease in GPA adherence, there was a 9% increase in the risk of gastrointestinal complications. “Our findings show that with every three day reduction of GPA coverage per 30 days of COX-2 inhibitor use, the risk of upper GI events increases 9%,” concludes Dr. Valkhoff.


Although the study population might have been a high risk population as far as gastro-intestinal bleeding concerns, the fact that in this study population not only the use of classic NSAIDs but also the use of COX-2 blocking agents can lead to a significantly increased risk for gastro-intestinal bleeding when adherence to concomitant gastroprotectve agents is low makes one think that the chronic use of COX-2 blocking agents without concomitant gastroprotective agents use is not as safe as we used to believe, and for sure not without risk. In this study patients were only on NSAIDs or COX-2 blocking agents for about 30 days, whereas in the rheumatological practice patients can be on NSAIDs or COX-2 inhibitors for months or years. To stay on the safe side should we not prescribe concomitant gastroprotective agents for ALL patients that take COX-2 inhibiting NSAIDs regardless of pre-existent risk for gastro-intestinal bleeding, and as such no longer make a difference between classic NSAIDs and COX-2 inhibitors as far as prescribing concomitant gastroprotective agents concerns?

Wiley: Not Taking Gastroprotective Drugs Prescribed with Anti-inflammatory Medicines Increases Risk of Upper GI Complications.

Update:
The study is also summarised and put in perspective to an other US-based study by Medpage Today, follow this link.

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