Variability in Risk of Gastrointestinal Complications With Different Nonsteroidal Anti-inflammatory Drugs

doi:10.1016/S0002-9343(97)00208-8

The American Journal of Medicine

Volume 104, Issue 3, Supplement 1, 30 March 1998, Pages 30S-34S

https://doi.org/10.1016/S0002-9343(97)00208-8 Get rights and content

Abstract

Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) is known to increase substantially the risk of upper gastrointestinal bleeding and/or perforation. A meta-analysis of the available epidemiologic studies has shown that there are wide differences between individual drugs in the risk of inducing gastrointestinal complications. Of the NSAIDs in common use, ibuprofen and diclofenac were found to be associated with the lowest relative risk; indomethacin, naproxen, sulindac, and aspirin were associated with intermediate risk; and azapropazone, tolmetin, ketoprofen, and piroxicam were associated with higher risk. Some of these apparent differences in toxicity may, however, be dose related. The low risk of gastrointestinal complications associated with ibuprofen appears to be attributable to the low doses that are prescribed routinely in clinical practice. Higher doses of ibuprofen were associated with relative risks similar to those of naproxen and indomethacin. Thus, as first-line treatment, patients should be prescribed the lowest effective dose of an NSAID that appears to be associated with a comparatively low risk. This should substantially reduce the morbidity and mortality from serious gastrointestinal complications that are associated with the use of these drugs.

Section snippets

Identification of Studies

Suitable studies for inclusion in the meta-analysis were found on the Medline/CD-ROM database for 1985–1994, inclusive. In addition, the bibliographies of previously published meta-analyses and reviews2, 9were searched. Authors of relevant studies were contacted and asked to supply detailed data. They were also sent a list of studies and asked whether they knew of any work that had been omitted.

Quality Assessment and Data Extraction

Controlled epidemiologic studies were identified that reported estimates of relative risk between

Results

Twelve studies were identified that satisfied the inclusion criteria.4, 5, 6, 7, 10, 11, 12, 13, 14, 15, 16, 17, 18Of the 14 NSAIDs investigated in these studies, 12 were included in two or more studies, and comparative data on ibuprofen and other agents were provided by 11 of the studies. One study was an update and re-analysis of a previously published paper,[18]and updated information on three other studies was provided by their authors.4, 10, 16Eleven of the papers described case control

Discussion

This meta-analysis suggested that ibuprofen was associated with the lowest relative risk of serious gastrointestinal complications, when compared with 11 other NSAIDs that had been investigated in two or more studies. There was no evidence that these findings could be explained by differences in the characteristics of the patients receiving the different drugs. The apparent advantage of ibuprofen remained, whether the analyses were based on the pooling of unadjusted relative risks calculated

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NSAIDs such as indomethacin play an anti-inflammatory role by inhibiting cyclooxygenase activity. However, NSAIDs can cause gastrointestinal bleeding and perforation risks, which are significantly related to drug dose (Garcia Rodriguez, 1998). Results of our previous study show that MSW is more effective than indomethacin is in treating gouty diseases, such as acute gouty arthritis (Shi et al., 2008).
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¹: A more complete description of the study outlined in this article has been published elsewhere.[1]

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ArticlesVariability in Risk of Gastrointestinal Complications With Different Nonsteroidal Anti-inflammatory Drugs 1

Abstract

Section snippets

Identification of Studies

Quality Assessment and Data Extraction

Results

Discussion

Lancet

Lancet

Gastroenterology

Lancet

Lancet

Control Clin Trials

Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugsresults of a collaborative meta-analysis

BMJ

The impact of research quality and study design on epidemiologic estimates of the effect of non-steroidal anti-inflammatory drugs on upper gastrointestinal tract disease

Arch Intern Med

Non-steroidal anti-inflammatory drugs and peptic ulcersfacts and figures multiply, but do they add up?

BMJ

Articles
Variability in Risk of Gastrointestinal Complications With Different Nonsteroidal Anti-inflammatory Drugs ¹