COX‐2‐selective inhibitors and the risk of upper gastrointestinal bleeding in high‐risk patients with previous gastrointestinal diseases: a population‐based case–control study

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Abstract
Summary: Background : Clinical trials have suggested that cyclo‐oxygenase‐2‐selective inhibitors are associated with a lower risk of upper gastrointestinal bleeding than are non‐selective, non‐aspirin, non‐steroidal anti‐inflammatory drugs. This has not yet been confirmed in studies of patients with an increased susceptibility to upper gastrointestinal bleeding.Aim : To examine the risk of upper gastrointestinal bleeding in high‐risk patients who filled prescriptions for cyclo‐oxygenase‐2 inhibitors or other non‐steroidal anti‐inflammatory drugs.Methods : A population‐based case–control study was performed in the Danish county of North Jutland from 1 January 2000 to 31 December 2002. From the County Hospital Discharge Registry and the Civil Registration System, we identified incident cases with upper gastrointestinal bleeding (n = 780) and randomly selected controls (n = 2906), respectively. All cases and controls had previous gastrointestinal diseases. Data on drug exposure were obtained from the countywide Prescription Database.Results : Thirty‐five cases (4.5%) filled prescriptionss for cyclo‐oxygenase‐2 inhibitors within 30 days of the date of upper gastrointestinal bleeding, compared with 79 controls (2.7%). Adjusted odds ratios for upper gastrointestinal bleeding according to prescription for celecoxib, rofecoxib and non‐steroidal anti‐inflammatory drugs were 1.3 [95% confidence interval (CI), 0.7–2.8], 2.1 (95% CI, 1.2–3.5) and 3.3 (95% CI, 2.4–4.4), respectively.Conclusions : In patients with increased susceptibility to gastrointestinal adverse events, a lower risk of upper gastrointestinal bleeding was observed in users of cyclo‐oxygenase‐2 inhibitors compared with users of other non‐aspirin, non‐steroidal anti‐inflammatory drugs.