[Can COX-2 selective inhibitor prevent NSAIDs-related GI toxicity?]

The gastrointestinal (GI) toxicity of non-steroidal anti-inflammatory drugs (NSAIDs) is well recognized. Risk factors for NSAIDs-related GI toxicity includes advanced age, generalized disease, past history of peptic ulcer, concomitant use of steroid, duplicated use of various NSAIDs. The guidelines recommended using a proton pump inhibitor or a prostaglandin for the treatment and prevention of NSAIDs-related GI toxicity. The updated guideline added cyclooxygenase-2 (COX-2) selective inhibitors, which have demonstrated equivalent efficacy to nonspecific NSAIDs in the management of arthritis and pain, to the prevention strategy. Several large, randomized, clinical trials compared the rates of serious GI events in patients taking COX-2 selective inhibitors and nonspecific NSAIDs but came to different conclusions. More recently, the overall safety profile of COX-2 selective inhibitors and traditional NSAIDs has come under intense debate especially due to the recently shown cardiovascular risk of COX-2 selective inhibitors. Therefore, it is essential to determine the actual risk of GI toxicity with COX-2 selective and traditional NSAIDs alone or combined with other compounds from independent Japan studies.