Strategies and practice for use of nonsteroidal anti-inflammatory drugs

Many nonsteroidal anti-inflammatory drugs (NSAIDs) have been developed and marketed since the discovery of aspirin in 1897. These agents frequently are prescribed for the management of arthritis symptoms, including joint pain and inflammation. Despite their therapeutic benefits, NSAIDs are known to be associated with serious gastrointestinal side effects, including ulceration, hemorrhage, and perforation. Thus, one of the main reasons for the continued development of new NSAIDs is the hope of of finding a drug with improved efficacy or safety. To date, clinically meaningful differences in the therapeutic efficacy of different NSAIDs have not been reported. However, recent studies have indicated that differences do exist in the gastrointestinal safety profiles of individual NSAIDs. This article reviews these studies and discusses strategies for NSAID use based on efficacy, safety, and cost issues.