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Titolo:
NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials?The gastroenterologist's perspective
Autore:
Hawkey, CJ;
Indirizzi:
Univ Nottingham Hosp, Queens Med Ctr, Div Gastroenterol, Nottingham NG7 2UH, England Univ Nottingham Hosp Nottingham England NG7 2UH tingham NG7 2UH, England
Titolo Testata:
CLINICAL AND EXPERIMENTAL RHEUMATOLOGY
fascicolo: 6, volume: 19, anno: 2001, supplemento:, 25
pagine: S23 - S30
SICI:
0392-856X(200111/12)19:6<S23:NACIWC>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; PLACEBO-CONTROLLED TRIAL; RANDOMIZED CONTROLLED TRIAL; DOUBLE-BLIND; RHEUMATOID-ARTHRITIS; GASTROINTESTINAL TOLERABILITY; CYCLOOXYGENASE-2 INHIBITOR; ULCER COMPLICATIONS; HEALTHY-SUBJECTS; GASTRIC-ULCER;
Keywords:
ulcers; outcomes; prostaglandins; NSAIDs; COX-2; inhibitors; clinical trial;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Hawkey, CJ Univ Nottingham Hosp, Queens Med Ctr, Div Gastroenterol, Nottingham NG7 2UH, England Univ Nottingham Hosp Nottingham England NG7 2UH 2UH, England
Citazione:
C.J. Hawkey, "NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials?The gastroenterologist's perspective", CLIN EXP RH, 19(6), 2001, pp. S23-S30

Abstract

Many studies have shown that a variety of strategies, including the use ofcyclooxygenase-2 (COX-2) inhibitors, or co-prescription of misoprostol or proton pump inhibitors, result in reduced endoscopic damage and ulceration compared with non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Questions have been raised as to whether this would translate into improved clinical outcomes. Consequently, several studies have investigated whether use of COX-2 inhibitors (Vioxx(R) Gastrointestinal Outcomes Research [VIGOR] and the Celecoxib Long-Term Arthritis Safety Assessment Study [CLASS] studies) or co-prescription with misoprostol (MUCOSA) would reduce the event rate of clinically significant ulcers. These studies have shown an approximate halving of suchevents. They have raised the possibility that use of low dose aspirin may compromise these benefits and appear to have shown differences between (at least some) COX-2 inhibitors and (at least some) NSAIDs with regard to myocardial infarction. Among the lessons learned from this experience are the need to define closely the outcomes of interest and possibly to concentrate on ulcer complications, the need for adequately powered studies, and the fact that endoscopicstudies broadly predict outcomes. However, there are differences in the estimated rates of reduction. It is not self evident whether outcomes studiesor endoscopic studies give a truer estimate of risk. A helpful developmentwould be more standardized gastrointestinal assessment at the time of ulcer complications and this could be achieved if studies were done in countries with well-developed primary care systems.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/02/20 alle ore 15:07:42