Stomach Safety: COX2s and NSAIDS
By Mary Anne Dunkin and Kerry Ludlam
Doctors and patients alike looked to COX-2s for relief of pain and inflammation when stomach safety was a concern. A 2005 study out of the United Kingdom cast doubt about whether COX-2s really are safer for stomachs, but some rheumatologists say it isn’t very conclusive.
The study looked at the medical records of nearly 88,000 people in England, Wales and Scotland. They identified 9,400 people who had ulcers to see if they had taken a traditional nonsteroidal anti-inflammatory drug (NSAID) or a COX-2 inhibitor, a type of NSAID thought to be safer for stomachs.
Almost 10 percent had been prescribed a COX-2 drug – either celecoxib (Celebrex) or rofecoxib (Vioxx), which is now off the market – and 45 percent had been prescribed a traditional NSAID. After accounting for other factors that might influence ulcer risk, the researchers found that the incidence of ulcer was highest among people using the traditional NSAIDs diclofenac, diflunisal, fenoprofen, flurbiprofen, indomethacin, ketoprofen, nabumetone, piroxicam and sulindac. Those using celecoxib (Celebrex) and rofecoxib (Vioxx) had a slightly increased risk. The lowest incidence was found in those who used aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn).
This study’s conclusion that COX-2 drugs are no safer for stomachs than other anti-inflammatory drugs shouldn’t be taken as a last word, say some physicians. Steven B. Abramson, MD, of New York University Medical Center and Hospital for Joint Diseases in New York, says the study isn’t clear and is weakened by lack of information. “You couldn’t tell if patients were taking COX-2s because they were at increased risk of ulcers to start with,” he says.
The bottom line? Be sure to review your risk factors for ulcers with your doctor before taking any type of anti-inflammatory medication.
