New data on drugs that affect ulcer healing
In patients who need treatment with non-steroidal anti-inflammatory drugs the risk of symptomatic ulcers is reduced by using cyclo-oxygenase-2 specific and selective NSAIDs, or by also using misoprostol and probably proton pump inhibitors, say researchers. However, a protective effect was not seen with H2-receptor antagonists.
In a recent systematic review, the researchers examined data on the effectiveness
of strategies to prevent NSAID-induced gastro-intestinal toxicity. They
analysed 156 clinical papers and concluded that the risk of symptomatic
ulcers is reduced by taking misoprostol with a non-selective NSAID (relative
risk 0.36, 95 per cent confidence interval 0.20–0.67); using COX-2
selective NSAIDs (0.41, 0.26–0.65); or COX-2 specific NSAIDs (0.49,
0.38–0.62); and probably by using a proton pump inhibitor with
a non-selective NSAID (0.09, 0.02–0.47).
They found that serious gastrointestinal complications are reduced with
the use of misoprostol (0.57, 0.36–0.91) and probably with COX-2
specific NSAIDs (0.55, 0.38–0.80), although they note that the
quality of these data is low because many publications did not report
all of these outcomes.
The researchers found no evidence of
effectiveness of H2-receptor antagonists, compared with placebo, for
any primary
outcome, although the data were insufficient to draw conclusions.
The researchers say that although all the strategies, except use of H2-receptor
antagonists, are apparently protective of symptomatic ulcers and all
strategies except COX-2 selectives are protective against endoscopic
ulcers, head-to-head studies and health economic reports are needed before
recommendations for practice can be made (BMJ 2004;329:948). |
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