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

Letter

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs

Why were patients at major risk excluded?

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

EDITOR—One of the strongest risk factors for gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs (NSAIDs) is known to be previous events. Hippisley-Cox et al excluded patients who had already had a diagnosis of an adverse upper gastrointestinal event before the study period.1 This removes patients at high risk from the analysis and introduces a fundamental bias. The large majority of the prescriptions of selective COX-2 inhibitors might well have been given to high risk patients who were subsequently excluded from the analysis.

Credit: DAVID M MARTING MD/SPL

The authors also do not provide the crude number of patients with concurrent prescriptions of ulcer healing drugs by each NSAID. The vast majority of ulcer healing drugs may well have been prescribed to patients taking a non-selective NSAID.

Another issue is the effect of concurrent anti-inflammatory drugs. The odds ratios were adjusted for each other NSAID group, smoking, comorbidity, deprivation, . . . [Full text of this article]

Luca Puccetti, president

Promed Galileo Medical Association, Pisa 56011, Italy lucpucce@promedgalileo.org


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

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]

Access jobs at BMJ Careers
Whats new online at Student BMJ