Review article: NSAIDs, gastroprotection and cyclo-oxygenase-II-selective inhibitors

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Non-steroidal anti-inflammatory drugs (NSAIDs) pose a risk of serious upper gastrointestinal complications.
• Gastroprotection strategies are crucial for high-risk individuals.

Purpose of the Study:

• To evaluate the efficacy of gastroprotective agents and the role of Helicobacter pylori eradication in mitigating NSAID-associated gastrointestinal toxicity.
• To assess the gastrointestinal safety profiles of newer NSAIDs compared to traditional ones.

Main Methods:

• Review of large clinical outcome trials assessing gastrointestinal complications.
• Analysis of data from trials like VIGOR and CLASS for newer NSAIDs (rofecoxib, celecoxib).

Main Results:

• Misoprostol (800 micro g/day) demonstrated a reduction in serious upper gastrointestinal complications in a major trial.
• Initial analyses of rofecoxib and celecoxib suggested gastrointestinal benefits over non-selective NSAIDs.
• Concerns regarding long-term gastrointestinal and cardiovascular safety profiles of rofecoxib and celecoxib have emerged.

Conclusions:

• Gastroprotection with misoprostol or proton pump inhibitors should be considered for high-risk NSAID users.
• Routine H. pylori testing and eradication are not currently recommended for NSAID users.
• The risk-benefit profiles of rofecoxib and celecoxib require further understanding before routine widespread use; their gastrointestinal safety compared to non-selective NSAIDs is not definitively established.
• Evidence supporting the use of meloxicam and etodolac over non-selective NSAIDs or coxibs is not robust due to inadequate trial data.