GI safety of coxibs demonstrated
Coxib drugs are less likely than meloxicam to cause upper gastrointestinal (GI) side effects, research has shown. However, they are more likely to cause strokes.
The findings come from studies conducted by the Drug Safety Research
Unit in Southampton. “The results reveal a significantly lower
rate of symptomatic upper GI events in users of rofecoxib or celecoxib
compared with meloxicam, and a significantly lower rate of complicated
upper GI conditions (perforations and bleeding) for users of celecoxib
compared with meloxicam,” said Professor Saad Shakir, director
of the unit. The results also demonstrated a higher rate of cerebrovascular
thromboembolic events with celecoxib and rofecoxib compared with meloxicam.
The researchers used data from the Prescription Pricing Authority. Patients
were identified from prescriptions. Altogether, data from 19,087 prescriptions
for meloxicam (Mobic), 17,458 prescriptions for celecoxib (Celebrex)
and 15,268 prescriptions for rofecoxib (Vioxx) were included.
In terms of GI events, a reduction in risk of symptomatic GI events in
the celecoxib group compared with the meloxicam group was identified.
During the nine months after starting treatment, 6.0 per cent of patients
in the celecoxib group and 7.2 per cent of patients in the meloxicam
group reported upper GI events (relative risk 0.77, 95 per cent confidence
interval 0.69–0.85). The study also showed that patients at high
risk of GI adverse events are being channelled towards receiving celecoxib
(Rheumatology 2003;42:1332).
The results for the rofecoxib versus meloxicam study are similar and
have already been published (see PJ, 7 September 2002, p309).
Two studies examined thromboembolic events (Rheumatology 2003;42:1342 and 1354). No difference in the rate of cardiovascular thromboembolic
events was identified for either rofecoxib or celecoxib compared with
meloxicam. However, an increased rate of cerebrovascular thromboembolic
events was identified, occurring in 0.39 per cent of patients on celecoxib,
0.48 per cent on rofecoxib and 0.27 per cent on meloxicam. A reduced
rate of peripheral venous thrombotic events was found in the rofecoxib
group compared with meloxicam. |
