BMJ  2005;331:1474 (17 December), doi:10.1136/bmj.331.7530.1474

Letter

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs

How strong is the evidence?

The first 150 words of the full text of this article appear below.

EDITOR—The major conclusion drawn from the nested case-control study by Hippisley-Cox et al was that no consistent evidence was found of enhanced safety against gastrointestinal events with any of the new cyclo-oxygenase-2 (COX-2) inhibitors compared with non-selective non-steroidal anti-inflammatory drugs (NSAIDs).1

The adjusted odds ratio for current use of rofecoxib in patients currently taking aspirin was 2.98 (2.24 to 3.99) whereas it was 1.22 (0.97 to 1.54) in those not currently taking aspirin. While denoting a strong interaction between rofecoxib and aspirin, these data do not support the view of a significant increased hazard of gastrointestinal outcome in patients taking rofecoxib alone.

The authors acknowledged that any observational study may be subject to residual confounding that cannot be fully corrected for. In this respect, the present study was based on drug prescriptions and not actual drug consumption. A low compliance rate with a given drug might result in . . . [Full text of this article]

Bernard G Bannwarth, professor of therapeutics

University Hospital, 33076 Bordeaux, France bernard.bannwarth@u-bordeaux2.fr


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Relevant Article

Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis
Julia Hippisley-Cox, Carol Coupland, and Richard Logan
BMJ 2005 331: 1310-1316. [Abstract] [Full Text] [PDF]

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