Key result
Relatively selective COX-2 inhibitors showed no significant difference compared to coxibs regarding ulcer complications and symptomatic ulcers.
Why the study?
Do relatively selective COX-2 inhibitors prevent NSAID-induced gastrointestinal injury as effectively as coxibs in patients requiring NSAID therapy?
Meta-Analysis (n=112,351)
Do relatively selective COX-2 inhibitors prevent NSAID-induced gastrointestinal injury as effectively as coxibs in patients requiring NSAID therapy?
Relatively selective COX-2 inhibitors appear to have a similar gastroprotective effect and tolerability profile as coxibs, though direct comparisons are lacking.
Answers are grounded in this paper and cite their sources.
Supports relatively selective COX-2 inhibitors as coxib alternatives for GI protection; leaves open need for direct head-to-head RCTs.
Currently 2 difference classes of cyclooxygenase (COX)-2 inhibitors, coxibs and relatively selective COX-2 inhibitors, are available for patients requiring nonsteroidal anti-inflammatory drug (NSAID) therapy; their gastroprotective effect is hardly directly compared. The aim of this study was to compare the gastroprotective effect of relatively selective COX-2 inhibitors with coxibs. MEDLINE, EMBASE, and the Cochrane Library (from their inception to March 2015) were searched for potential eligible studies. We included randomized controlled trials comparing coxibs (celecoxib, etoricoxib, parecoxib, and lumiracoxib), relatively selective COX-2 inhibitors (nabumetone, meloxicam, and etodolac), and nonselective NSAIDs with a study duration ≥ 4 weeks. Comparative effectiveness and safety data were pooled by Bayesian network meta-analysis. The primary outcomes were ulcer complications and symptomatic ulcer. Summary effect-size was calculated as risk ratio (RR), together with the 95% confidence interval (CI). This study included 36 trials with a total of 112,351 participants. Network meta-analyses indicated no significant difference between relatively selective COX-2 inhibitors and coxibs regarding ulcer complications (RR, 1.38; 95% CI, 0.47-3.27), symptomatic ulcer (RR, 1.02; 95% CI, 0.09-3.92), and endoscopic ulcer (RR, 1.18; 95% CI, 0.37-2.96). Network meta-analyses adjusting potential influential factors (age, sex, previous ulcer disease, and follow-up time), and sensitivity analyses did not reveal any major change to the main results. Network meta-analyses suggested that relatively selective COX-2 inhibitors and coxibs were associated with comparable incidences of total adverse events (AEs) (RR, 1.09; 95% CI, 0.93-1.31), gastrointestinal AEs (RR, 1.04; 95% CI, 0.87-1.25), total withdrawals (RR, 1.00; 95% CI, 0.74-1.33), and gastrointestinal AE-related withdrawals (RR, 1.02; 95% CI, 0.57-1.74). Relatively selective COX-2 inhibitors appear to be associated with similar gastroprotective effect and tolerability as coxibs. Owing to the indirectness of the comparisons, future research is required to confirm the study conclusion.
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Yang et al. (2015) conducted a meta-analysis in NSAID-Induced Gastrointestinal Injury (n=112,351). Relatively selective COX-2 inhibitors vs. Coxibs was evaluated on Ulcer complications (RR 1.38, 95% CI 0.47-3.27). Relatively selective COX-2 inhibitors showed no significant difference compared to coxibs regarding ulcer complications and symptomatic ulcers.
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