Risk reduction in patients taking NSAIDS and COX-2 inhibitors
As a surgeon with a large oesophageal practice I am deeply concerned
that the recent scare and confusion around COX-2 inhibitors, as referred
to in ‘Lessons from the withdrawal of rofecoxib’ (BMJ 2004; 329:867-868),
will increase the already alarming proportion of patients taking anti-
inflammatories who suffer oesophageal, gastric and duodenal ulceration –
with potentially fatal consequences.
Prescriptions of traditional non-steroidal anti-inflammatory drugs
(NSAIDs) will undoubtedly continue to rise and my worry is that this will
be done without enough consideration given to their side effect profile -
it is already well documented that an estimated 30% of regular users
develop peptic ulcers1.
Currently the debate as to whether it is appropriate to switch to
another COX-2 inhibitor or switch to the older NSAIDs remains unresolved.
Regardless of which side of the fence anyone sits, as a surgeon, I would
strongly urge clinicians to protect their patients against the gastro-
intestinal side effects associated with NSAIDs and also COX-2 inhibitors.
This can be achieved effectively and simply by considering concomitant
proton pump inhibitor (PPI) prescribing - particularly for those at high
risk (those with a history of peptic ulcer and / or older than 60 years).
Most PPIs are licensed for the prevention of gastro-intestinal ulcers
and healing in those taking NSAID’s but only esomeprazole has data for
concomitant use with COX-2 inhibitors2, on the basis of which it has
recently been approved for use with this class of drugs.
Reference:
1. Laine L. The gastrointestinal effects of nonselective NSAIDs and COX-2-
selective inhibitors. Semin Arthritis Rheum 2002; 32 Suppl 1; 25-32.
2. Schieman JMet al. Esomeprazole prevents gastric and duodenal ulcers in
at-risk patients on continuous non-selective or COX-2-selective NSAID
therapy. Gastroenterology 2004;126(4 Suppl 2):A-82, Abs 638.
Competing interests:
I have been involved in Multi Centre studies sponsored by AstraZeneca and have received honoraria for lecturing at sponsored medical meetings.
Rapid Response:
Risk reduction in patients taking NSAIDS and COX-2 inhibitors
As a surgeon with a large oesophageal practice I am deeply concerned
that the recent scare and confusion around COX-2 inhibitors, as referred
to in ‘Lessons from the withdrawal of rofecoxib’ (BMJ 2004; 329:867-868),
will increase the already alarming proportion of patients taking anti-
inflammatories who suffer oesophageal, gastric and duodenal ulceration –
with potentially fatal consequences.
Prescriptions of traditional non-steroidal anti-inflammatory drugs
(NSAIDs) will undoubtedly continue to rise and my worry is that this will
be done without enough consideration given to their side effect profile -
it is already well documented that an estimated 30% of regular users
develop peptic ulcers1.
Currently the debate as to whether it is appropriate to switch to
another COX-2 inhibitor or switch to the older NSAIDs remains unresolved.
Regardless of which side of the fence anyone sits, as a surgeon, I would
strongly urge clinicians to protect their patients against the gastro-
intestinal side effects associated with NSAIDs and also COX-2 inhibitors.
This can be achieved effectively and simply by considering concomitant
proton pump inhibitor (PPI) prescribing - particularly for those at high
risk (those with a history of peptic ulcer and / or older than 60 years).
Most PPIs are licensed for the prevention of gastro-intestinal ulcers
and healing in those taking NSAID’s but only esomeprazole has data for
concomitant use with COX-2 inhibitors2, on the basis of which it has
recently been approved for use with this class of drugs.
Reference:
1. Laine L. The gastrointestinal effects of nonselective NSAIDs and COX-2-
selective inhibitors. Semin Arthritis Rheum 2002; 32 Suppl 1; 25-32.
2. Schieman JMet al. Esomeprazole prevents gastric and duodenal ulcers in
at-risk patients on continuous non-selective or COX-2-selective NSAID
therapy. Gastroenterology 2004;126(4 Suppl 2):A-82, Abs 638.
Competing interests:
I have been involved in Multi Centre studies sponsored by AstraZeneca and have received honoraria for lecturing at sponsored medical meetings.
Competing interests: No competing interests