[Anti-inflammatory non-steroidal selective cyclooxygenase 2 inhibitors and gastroduodenal lesions]

NSAID CATEGORIES: Contrary to classical NSAIDs, which inhibit the 2 isoforms of cyclo-oxygenase (COX), coxibs do not affect COX-1, which catalyses the synthesis of cytoprotective prostaglandins in the stomach.

The probability of developing a symptomatic, uncomplicated or complicated (perforation, gastric outlet obstruction, bleeding) gastroduodenal ulcer is significantly lower with a COX-2 selective inhibitor (Celecoxib, rofecoxib) than with a traditional NSAIDs, with a reduction in absolute risk of around 1-1.5 for 100 patient-years in clinical trials. The gastrointestinal toxicity of coxibs is greater than that of a placebo. THE INFLUENCE OF A CO-PRESCRIPTION OF ASPIRIN: Patients for whom low-dose aspirin is indicated to offset known thrombotic risk must continue this therapy if a COX-2 selective inhibitor is introduced. In that case, however, coxibs expose the patient to almost the same risk of severe gastroduodenal complications as with classical NSAIDs.

In view of the lesser ulcerogenic potential of coxibs, patients at risk of gastrointestinal complications are the population of choice for these drugs. In the case of concomitant ingestion of aspirin for prevention of thrombosis, some authors prefer the association of classical NSAIs with proton pump inhibitors (omeprazole, lansoprazole) or misoprostol.