An evidence-based approach to the gastrointestinal safety profile of COX-2-selective anti-inflammatories.
Evidence-based medicine (EBM) provides frameworks for the systematic review of study methodology and results. Thus, EBM frameworks facilitate assessing a study's ability to produce unbiased and accurate results and applying the results to the management of individual patients. Using EBM frameworks, published literature about risk factors for serious NSAID-associated gastrointestinal (GI) disorders, GI safety of COX-2 selective NSAIDs, and GI safety of co-therapy of proton pump inhibitors and NSAIDs are reviewed. This article concludes with evidence-based recommendations concerning which patients are at high risk for serious NSAID-associated GI disorders and which therapies are most effective in reducing serious NSAID-associated GI disorders.
Schoenfeld
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Division of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Veterans Affairs Center of Excellence for Health Services Research, Ann Arbor, Michigan, USA. pschoenf@umich.edu
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D007783:Lactones / Q000009:adverse effects / Q000627:therapeutic use; D008565:Membrane Proteins; D010003:Osteoarthritis / Q000188:drug therapy; D011451:Prostaglandin-Endoperoxide Synthases; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013450:Sulfones
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D007783:Lactones; D008565:Membrane Proteins; D054328:Proton Pump Inhibitors; D013450:Sulfones; C116926:rofecoxib; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases