Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: defining the role of gastroprotective agents.


Journal Article (Review)

Treatment with anti-inflammatory drugs and the analgesic efficacy of conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are compromised by a two- to fourfold increased risk of gastrointestinal complications. This increased risk has resulted in an increasing use of the new selective cyclooxygenase-2 inhibitors or coxibs, which, in clinical trials and outcomes studies, reduced gastrointestinal adverse events by 50% to 65% compared with conventional NSAIDs. However, the coxibs are not available to all patients who need them, and NSAIDs are still widely used. Moreover, treatment with a coxib cannot heal pre-existing gastrointestinal lesions, and cotherapy with an anti-secretory drug or mucosal protective agent may be required. This paper addresses the management of patients with risk factors for gastrointestinal complications who are taking NSAIDs and makes recommendations for the appropriate use of 'gastroprotective' agents (GPAs) in patients who need to take an NSAID or a coxib. When economically possible, a coxib alone is preferable to a conventional NSAID plus a GPA to minimize exposure to potential gastrointestinal damage and avoid unnecessary dual therapy. Patients at high risk require a GPA in addition to a coxib.

Full Text

Duke Authors

Cited Authors

  • Hunt, RH; Barkun, AN; Baron, D; Bombardier, C; Bursey, FR; Marshall, JR; Morgan, DG; Paré, P; Thomson, ABR; Whittaker, JS

Published Date

  • April 2002

Published In

Volume / Issue

  • 16 / 4

Start / End Page

  • 231 - 240

PubMed ID

  • 11981576

Pubmed Central ID

  • 11981576

Electronic International Standard Serial Number (EISSN)

  • 1916-7237

International Standard Serial Number (ISSN)

  • 0835-7900

Digital Object Identifier (DOI)

  • 10.1155/2002/516092


  • eng