Selective COX-2 inhibitors were associated with a lower short-term risk of upper gastrointestinal hemorrhage compared with non-selective NSAIDs (adjusted rate ratio 4.4 for NSAIDs vs celecoxib).
Cohort (n=143,969)
Do selective COX-2 inhibitors reduce the risk of upper gastrointestinal haemorrhage compared to non-selective NSAIDs in elderly patients?
In elderly patients, selective COX-2 inhibitors (particularly celecoxib) are associated with a lower short-term risk of upper gastrointestinal hemorrhage compared to non-selective NSAIDs.
Effect estimate: RR 4.4 (95% CI 2.3 to 8.5)
OBJECTIVE: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN: Observational cohort study. SETTING: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. PATIENTS: Subjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). MAIN OUTCOME MEASURES: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. RESULTS: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). CONCLUSIONS: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs.
Mamdani et al. (Thu,) conducted a cohort in NSAID-naive elderly patients (n=143,969). Selective COX-2 inhibitors (rofecoxib, celecoxib) vs. Non-selective NSAIDs, diclofenac plus misoprostol, and no NSAIDs was evaluated on hospital admission for upper gastrointestinal haemorrhage (RR 4.4, 95% CI 2.3 to 8.5). Selective COX-2 inhibitors were associated with a lower short-term risk of upper gastrointestinal hemorrhage compared with non-selective NSAIDs (adjusted rate ratio 4.4 for NSAIDs vs celecoxib).