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Healio
May 19, 2016
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COX-2 inhibitors plus PPIs provide best protection against NSAID-induced ulcers

Combining selective COX-2 inhibitors with proton pump inhibitors is the best strategy for reducing the risk for NSAID-induced GI toxicity, according to the results of a systematic review and meta-analysis.

“The combination of a COX-2-selective NSAID with a PPI will be expensive and is not recommended for all patients who need to be on an NSAID,” Jin Ling Tang, MD, PhD, from the School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, said in a press release. “However, it is the safest and most effective treatment strategy for those at high risk of ulcer bleeding from NSAID treatment.”

To compare the safety and efficacy of current preventive strategies against NSAID-induced GI toxicity, Tang and colleagues searched relevant literature for randomized trials published up to May 2015 that compared GI adverse event risk in patients taking nonselective NSAIDs, selective COX-2 inhibitors or nonselective NSAIDs/COX-2 inhibitors plus gastroprotective agents. They included 82 trials with 125,053 participants in a pairwise meta-analysis and a Bayesian network meta-analysis. Ulcer complications and symptomatic ulcers served as the primary outcomes.

The network meta-analysis showed the following strategies were associated with a lower risk for clinical GI events compared with nonselective NSAIDs:

  • Selective COX-2 inhibitors plus PPIs (RR for ulcer complications = 0.07; 95% CI, 0.02-0.18);
  • Selective COX-2 inhibitors alone (RR for ulcer complications = 0.25; 95% CI, 0.15-0.38; RR for symptomatic ulcer = 0.12; 95% CI, 0.04-0.3);
  • Nonselective NSAIDs plus PPIs (RR for ulcer complications = 0.28; 95% CI, 0.18-0.41; RR for symptomatic ulcer = 0.11; 95% CI, 0.04-0.23); and
  • Nonselective NSAIDs plus misoprostol (RR for ulcer complications = 0.47; 95% CI, 0.24-0.81; RR for symptomatic ulcer = 0.41; 95% CI, 0.13-1).

“Overall, this systematic review indicated that the combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs,” the researchers concluded. “These strategies also show favorable tolerability.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

Sources/Disclosures

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Source:

Yuan JQ, et al. Aliment Pharmacol Ther. 2016;doi:10.1111/apt.13642.