title: Celecoxib Monotherapy Maintained Small Intestinal Mucosa Better Compared With Loxoprofen Plus Lansoprazole Treatment: A Double-blind, Randomized, Controlled Trial.
abstract: OBJECTIVE
  The aim of this study was to compare celecoxib with loxoprofen for protection of small intestine.
  
  
  BACKGROUND
  RCT studies report that COX-2 selective inhibitor celecoxib induces fewer small intestinal injuries than nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). Loxoprofen is a prodrug nonselective NSAID developed to protect upper gastrointestinal tract.
  
  
  METHODS
  A total of 150 healthy volunteers (40 to 70 y) were enrolled. After medical checkup including laboratory data, subjects were randomly assigned to celecoxib (200 mg daily) or loxoprofen (180 mg daily) plus lansoprazole (15 mg daily). All drugs were prepared using inactive capsules. After randomization, all subjects were first examined by baseline capsule endoscopy (CE). After 14 days, subjects underwent posttreatment CE. We compared baseline and posttreatment CE findings of the 2 groups. All CE data were evaluated blindly by 3 reviewers. Pretreatment and posttreatment laboratory variables were also compared.
  
  
  RESULTS
  A total of 74 subjects (49±6 y, F/M: 36/38) were enrolled in celecoxib group and 76 subjects (49±7 y, F/M: 39/37)in loxoprofen group. Five in celecoxib group and 4 in loxoprofen group were excluded from CE analysis mainly due to incomplete CE. The percentage of subjects with at least 1 posttreatment mucosal break was lower in celecoxib group (10%) than in loxoprofen group (49%) (P<0.0001). A total of 0.3±1.0 posttreatment small intestinal mucosal breaks were detected in the celecoxib group, and 6.8±21.5 in the loxoprofen group (P<0.0001). Posttreatment hemoglobin concentration in loxoprofen group (5.1% reduction) was lower compared with celecoxib group (2.1% reduction) (P=0.006).
  
  
  CONCLUSIONS
  In terms of protection of small intestine from NSAIDs toxicity, celecoxib monotherapy was superior to loxoprofen+lansoprazole combination therapy (UMIN: 000007936).
authors.affiliation: *Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Bunkyo-ku †Medical Co. LTA Sumida Hospital, Sumida-ku ‡The Third Department of Internal Medicine, Kyorin University School of Medicine, Mitaka §Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Fujimori
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Hanada
authors.forename: Mari
authors.initials: M
authors.lastname: Hayashida
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Ippei
authors.initials: I
authors.lastname: Ikushima
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D053704:Capsule Endoscopy; D000068579:Celecoxib / Q000494:pharmacology*; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000473:pathology; D064747:Lansoprazole / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010666:Phenylpropionates / Q000494:pharmacology*; D054328:Proton Pump Inhibitors / Q000494:pharmacology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D006454:Hemoglobins; D010666:Phenylpropionates; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; C040656:loxoprofen; D000068579:Celecoxib