Abstract | PURPOSE: METHODS: We performed a systematic review to identify trials comparing either a Coxib versus NSAID or NSAID+PPI versus NSAID in chronic arthritis. We selected studies that report incident dyspepsia, defined a priori as "epigastric pain," " dyspepsia," and " nausea." We then performed meta-analysis to compare the relative risk reduction and absolute risk reduction of dyspepsia for Coxib versus NSAID and NSAID+PPI versus NSAID. RESULTS: Meta-analysis of 26 studies comparing dyspepsia between Coxibs and NSAIDs revealed a 12% relative risk reduction for Coxibs with an absolute risk reduction of 3.7%. Meta-analysis of four studies comparing dyspepsia between the NSAID+PPI combination and NSAIDs alone revealed a 66% relative risk reduction for NSAID+PPI with an absolute risk reduction of 9%. Compared with the NSAID strategy, the number needed to treat to prevent dyspepsia was 27 for Coxibs and 11 for NSAID+PPI. CONCLUSION: NSAID+PPI affords greater risk reduction for dyspepsia than Coxibs when compared with the common baseline of NSAIDs. Because there are limited head-to-head data comparing Coxibs versus NSAID+PPI, these data provide the best indirect evidence that NSAID+PPI may be superior to Coxibs in minimizing incident dyspepsia.
|
Authors | Brennan M R Spiegel, Mary Farid, Gareth S Dulai, Ian M Gralnek, Fasiha Kanwal |
Journal | The American journal of medicine
(Am J Med)
Vol. 119
Issue 5
Pg. 448.e27-36
(May 2006)
ISSN: 1555-7162 [Electronic] United States |
PMID | 16651060
(Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Systematic Review)
|
Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Cyclooxygenase 2 Inhibitors
- Enzyme Inhibitors
- Proton Pump Inhibitors
|
Topics |
- Anti-Inflammatory Agents, Non-Steroidal
(adverse effects, therapeutic use)
- Arthritis
(drug therapy)
- Cyclooxygenase 2 Inhibitors
(adverse effects, therapeutic use)
- Drug Therapy, Combination
- Dyspepsia
(chemically induced, epidemiology)
- Enzyme Inhibitors
(adverse effects, therapeutic use)
- Humans
- Incidence
- Proton Pump Inhibitors
- Risk Factors
|