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Comparative incidence of upper gastrointestinal bleeding associated with individual non-steroidal anti-inflammatory

M J Llorente Melero1, J M Tenías Burillo, A Zaragoza Marcet

  • 1Unit of Rheumatology, Lluís Alcanyís Hospital, Xátiva, Valencia, Spain. JOTEBU@mail.ono.es

Revista Espanola De Enfermedades Digestivas
|June 21, 2002
PubMed
Abstract

Insights

Choosing nonsteroidal anti-inflammatory drugs (NSAIDs) with preferential cyclo-oxygenase-2 (COX-2) inhibition can significantly reduce the risk of upper gastrointestinal bleeding (UGIB). This study highlights the varying GI toxicity among NSAIDs, emphasizing COX-2 preferential agents for safer use.

Area of Science:

  • Pharmacology
  • Gastroenterology
  • Clinical Medicine

Background:

  • Cyclo-oxygenase (COX) exists in two isoforms: COX-1 and COX-2.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibiting COX-1 are associated with gastrointestinal (GI) damage.
  • NSAIDs with a higher COX-2/COX-1 inhibition ratio may offer reduced GI toxicity.

Purpose of the Study:

  • To compare the incidence of upper gastrointestinal bleeding (UGIB) across specific NSAIDs.
  • To evaluate the role of "COX-2 preferential" inhibitors in mitigating GI toxicity.

Main Methods:

  • An observational study estimating NSAID-related UGIB incidence over four years.
  • Data collected from UGIB cases, NSAID sales, and community dosage information.
  • Rate ratios (RR) and 95% confidence intervals (CI) calculated, referencing NSAIDs with the lowest UGIB incidence.

Main Results:

  • UGIB incidence varied significantly among thirteen NSAIDs, ranging from 1.7 to 25.8 per 1,000 person-years.
  • "COX-1 preferential" inhibitors showed a 5.3 times higher RR of UGIB compared to "COX-2 preferential" inhibitors.
  • NSAIDs with "COX-1-COX-2 mixed" inhibition had a 2.2 times higher RR of UGIB.

Conclusions:

  • Significant differences in GI toxicity exist among specific NSAIDs.
  • Utilizing NSAIDs with "COX-2 preferential" inhibition could lead to a substantial decrease in UGIB cases.
  • This suggests a safer therapeutic approach by selecting NSAIDs with a favorable COX-2/COX-1 inhibition profile.

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