Nonsteroidal anti-inflammatory drugs (NSAIDs), cyxlo-oxygenase-2 selective inhibitors (coxibs) and gastrointestinal harm: a systematic review of clinical trials and clinical practice

R Andrew Moore, Sheena Derry, Ceri J Phillips and Henry J McQuay

Gastrointestinal harm, known to occur with NSAIDs, is thought to be lower with NSAID and gastroprotective agent, and with inhibitors selective to cyclooxygenase-2 (coxibs) at usual plasma concentrations. This study examined competing strategies for available evidence of reduced gastrointestinal bleeding in clinical trials and combine this evidence with evidence from clinical practice on whether the strategies work in the real world, whether guidance on appropriate prescribing is followed, and whether patients adhere to the strategies. The authors conclude that evidence for efficacy of gastroprotection strategies with NSAIDs is limited. In clinical practice few patients who need gastroprotection get it, and those who get it may not take it. For coxibs, gastroprotection is inherent, although probably not complete.

BMC Musculoskeletal Disorders 2006, 7:79

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