title: Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis--an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks.
abstract: BACKGROUND
  There are several guidelines addressing the issues around the use of NSAIDs. However, none has specifically addressed the upper versus lower gastrointestinal (GI) risk of COX-2 selective and non-selective compounds nor the interaction at both the GI and cardiovascular (CV) level of either class of drugs with low-dose aspirin. This Consensus paper aims to develop statements and guidance devoted to these specific issues through a review of current evidence by a multidisciplinary group of experts.
  
  
  METHODS
  A modified Delphi consensus process was adopted to determine the level of agreement with each statement and to determine the level of agreement with the strength of evidence to be assigned to the statement.
  
  
  RESULTS
  For patients with both low GI and CV risks, any non-selective NSAID (ns-NSAID) alone may be acceptable. For those with low GI and high CV risk, naproxen may be preferred because of its potential lower CV risk compared with other ns-NSAIDs or COX-2 selective inhibitors, but celecoxib at the lowest approved dose (200 mg once daily) may be acceptable. In patients with high GI risk, if CV risk is low, a COX-2 selective inhibitor alone or ns-NSAID with a proton pump inhibitor appears to offer similar protection from upper GI events. However, only celecoxib will reduce mucosal harm throughout the entire GI tract. When both GI and CV risks are high, the optimal strategy is to avoid NSAID therapy, if at all possible.
  
  
  CONCLUSIONS
  Time is now ripe for offering patients with osteoarthritis the safest and most cost-effective therapeutic option, thus preventing serious adverse events which could have important quality of life and resource use implications. Please see related article: http://dx.doi.org/10.1186/s12916-015-0291-x.
authors: Carmelo
authors: C
authors: Scarpignato
authors: Angel
authors: A
authors: Lanas
authors: Corrado
authors: C
authors: Blandizzi
authors: Willem F
authors: WF
authors: Lems
authors: Matthias
authors: M
authors: Hermann
authors: Richard H
authors: RH
authors: Hunt
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D012306:Risk; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal