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

Letter

Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs

COX-2 inhibitors were thought of as a safe option

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

EDITOR—The study by Hippisley-Cox et al into the safety of cyclo-oxygenase-2 (COX-2) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDS) is subject to more indication bias than they suggest.¹

When the study began, five years ago, COX-2 inhibitors were widely regarded as safer to prescribe in patients at high risk of developing gastrointestinal side effects than NSAIDs,² although there were doubts over their cardiovascular safety.³ Working in general practice at the time, we saw COX-2 inhibitors used in primary care patients who had mild upper gastrointestinal symptoms or history, as a safe option. They were prescribed particularly in elderly people, in whom opiate analgesics often cause significant adverse effects. This practice would have led to a higher risk cohort of patients being prescribed COX-2 inhibitors rather than NSAIDs, thus reducing the apparent safety of COX-2 inhibitors in this study.

Additionally, during the study period both ulcer healing drugs and NSAIDs . . . [Full text of this article]

¹ Welshpool Medical Centre, Powys SY21 7ER Michael.Lewis@gp-w96010.wales.nhs.uk, ² Cheam Family Practice, Sutton, Surrey SM1 2HD

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