Gastrointestinal side‐effects of traditional non‐steroidal anti‐inflammatory drugs and new formulations

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Abstract
Summary: Although adverse effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) occur in only a small proportion of users, the widespread use of these drugs has resulted in a substantial overall number of affected persons who experience serious gastrointestinal complications. Dyspeptic symptoms are estimated to occur in 10–60% of NSAID users and lead to discontinuation of treatment in 5–15% of rheumatoid arthritis patients taking NSAIDs. It is now well established that the point prevalence of peptic ulcer disease in patients receiving conventional NSAID therapy ranges between 10 and 30%, representing a 10–30‐fold increase over that found in the general population. One of 175 users of conventional NSAIDs in the USA will be hospitalized each year for NSAID‐induced gastrointestinal damage. The mortality of hospitalized patients remains about 5–10%, with an expected annual death rate of 0.08%. The selective COX‐II inhibitors (rofecoxib, celecoxib, parecoxib, etoricoxib, valdecoxib, lumiracoxib) show consistently comparable efficacy to that of conventional non‐steroidal anti‐inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis and osteoarthritis, but have a significantly reduced propensity to cause gastrointestinal toxicity. In many cases, the gastric effects of therapeutically active doses of COX‐II inhibitors are indistinguishable from placebo. The safety benefits of COX‐2 inhibitors given alone appear similar to combined therapy with conventional NSAIDs and gastroprotective agents. These findings warrant the consideration of COX‐II inhibitors as first‐line therapy in patients requiring long‐term pain control.