[Anti-inflammatory non-steroidal selective cyclooxygenase 2 inhibitors and gastroduodenal lesions].

Abstract

NSAID CATEGORIES: Contrary to classical NSAIDs, which inhibit the 2 isoforms of cyclo-oxygenase (COX), coxibs do not affect COX-1, which catalyses the synthesis of cytoprotective prostaglandins in the stomach.

ULCER COMPLICATIONS:

The probability of developing a symptomatic, uncomplicated or complicated (perforation, gastric outlet obstruction, bleeding) gastroduodenal ulcer is significantly lower with a COX-2 selective inhibitor (Celecoxib, rofecoxib) than with a traditional NSAIDs, with a reduction in absolute risk of around 1-1.5 for 100 patient-years in clinical trials. The gastrointestinal toxicity of coxibs is greater than that of a placebo. THE INFLUENCE OF A CO-PRESCRIPTION OF ASPIRIN: Patients for whom low-dose aspirin is indicated to offset known thrombotic risk must continue this therapy if a COX-2 selective inhibitor is introduced. In that case, however, coxibs expose the patient to almost the same risk of severe gastroduodenal complications as with classical NSAIDs.

TARGET POPULATION:

In view of the lesser ulcerogenic potential of coxibs, patients at risk of gastrointestinal complications are the population of choice for these drugs. In the case of concomitant ingestion of aspirin for prevention of thrombosis, some authors prefer the association of classical NSAIs with proton pump inhibitors (omeprazole, lansoprazole) or misoprostol.

• Authors: Bernard Bannwarth
• Journal: Presse medicale (Paris, France : 1983) (Presse Med) Vol. 31 Issue 31 Pg. 1469-75 (Sep 28 2002) ISSN: 0755-4982 [Print] France
• Vernacular Title: Anti-inflammatoires non stéroïdiens inhibiteurs sélectifs de la cyclo-oxygénase 2 et lésions gastroduodénales.
• PMID: 12395741 (Publication Type: English Abstract, Journal Article, Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Cyclooxygenase Inhibitors
• Aspirin

Topics

• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Aspirin (adverse effects, therapeutic use)
• Clinical Trials as Topic
• Cyclooxygenase Inhibitors (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Humans
• Peptic Ulcer (chemically induced, prevention & control)
• Risk Factors
• Structure-Activity Relationship