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Article: Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis

TitleCelecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis
Authors
Issue Date2002
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
Citation
New England Journal Of Medicine, 2002, v. 347 n. 26, p. 2104-2110 How to Cite?
AbstractBackground: Current guidelines recommend that patients at risk for ulcer disease who require treatment for arthritis receive nonsteroidal antiinflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 or the combination of a nonselective NSAID with a proton-pump inhibitor. We assessed whether celecoxib would be similar to diclofenac plus omeprazole in reducing the risk of recurrent ulcer bleeding in patients at high risk for bleeding. Methods: We studied patients who used NSAIDs for arthritis and who presented with ulcer bleeding. After their ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 200 mg of celecoxib twice daily plus daily placebo or 75 mg of diclofenac twice daily plus 20 mg of omeprazole daily for six months. The end end point was recurrent ulcer bleeding. Results: In the intention-to-treat analysis, which included 287 patients (144 receiving celecoxib and 143 receiving diclofenac plus omeprazole), recurrent ulcer bleeding occurred in 7 patients receiving celecoxib and 9 receiving diclofenac plus omeprazole. The probability of recurrent bleeding during the six-month period was 4.9 percent (95 percent confidence interval, 3.1 to 6.7) for patients who received celecoxib and 6.4 percent (95 percent confidence interval, 4.3 to 8.4) for patients who received diclofenac plus omeprazole (difference, - 1.5 percentage points; 95 percent confidence interval for the difference, -6.8 to 3.8). Renal adverse events, including hypertension, peripheral edema, and renal failure, occurred in 24.3 percent of the patients receiving celecoxib and 30.8 percent of those receiving diclofenac plus omeprazole. Conclusions: Among patients with a recent history of ulcer bleeding, treatment with celecoxib was as effective as treatment with diclofenac plus omeprazole, with respect to the prevention of recurrent bleeding. Renal toxic effects are common in high-risk patients receiving celecoxib or diclofenac plus omeprazole. Copyright © 2002 Massachusetts Medical Society.
Persistent Identifierhttp://hdl.handle.net/10722/162662
ISSN
2015 Impact Factor: 59.558
2015 SCImago Journal Rankings: 14.619
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, FKLen_US
dc.contributor.authorHung, LCTen_US
dc.contributor.authorSuen, BYen_US
dc.contributor.authorWu, JCYen_US
dc.contributor.authorLee, KCen_US
dc.contributor.authorLeung, VKSen_US
dc.contributor.authorHui, AJen_US
dc.contributor.authorTo, KFen_US
dc.contributor.authorLeung, WKen_US
dc.contributor.authorWong, VWSen_US
dc.contributor.authorChung, SCSen_US
dc.contributor.authorSung, JJYen_US
dc.date.accessioned2012-09-05T05:22:10Z-
dc.date.available2012-09-05T05:22:10Z-
dc.date.issued2002en_US
dc.identifier.citationNew England Journal Of Medicine, 2002, v. 347 n. 26, p. 2104-2110en_US
dc.identifier.issn0028-4793en_US
dc.identifier.urihttp://hdl.handle.net/10722/162662-
dc.description.abstractBackground: Current guidelines recommend that patients at risk for ulcer disease who require treatment for arthritis receive nonsteroidal antiinflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 or the combination of a nonselective NSAID with a proton-pump inhibitor. We assessed whether celecoxib would be similar to diclofenac plus omeprazole in reducing the risk of recurrent ulcer bleeding in patients at high risk for bleeding. Methods: We studied patients who used NSAIDs for arthritis and who presented with ulcer bleeding. After their ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 200 mg of celecoxib twice daily plus daily placebo or 75 mg of diclofenac twice daily plus 20 mg of omeprazole daily for six months. The end end point was recurrent ulcer bleeding. Results: In the intention-to-treat analysis, which included 287 patients (144 receiving celecoxib and 143 receiving diclofenac plus omeprazole), recurrent ulcer bleeding occurred in 7 patients receiving celecoxib and 9 receiving diclofenac plus omeprazole. The probability of recurrent bleeding during the six-month period was 4.9 percent (95 percent confidence interval, 3.1 to 6.7) for patients who received celecoxib and 6.4 percent (95 percent confidence interval, 4.3 to 8.4) for patients who received diclofenac plus omeprazole (difference, - 1.5 percentage points; 95 percent confidence interval for the difference, -6.8 to 3.8). Renal adverse events, including hypertension, peripheral edema, and renal failure, occurred in 24.3 percent of the patients receiving celecoxib and 30.8 percent of those receiving diclofenac plus omeprazole. Conclusions: Among patients with a recent history of ulcer bleeding, treatment with celecoxib was as effective as treatment with diclofenac plus omeprazole, with respect to the prevention of recurrent bleeding. Renal toxic effects are common in high-risk patients receiving celecoxib or diclofenac plus omeprazole. Copyright © 2002 Massachusetts Medical Society.en_US
dc.languageengen_US
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/en_US
dc.relation.ispartofNew England Journal of Medicineen_US
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal - Adverse Effects - Therapeutic Useen_US
dc.subject.meshAnti-Ulcer Agents - Therapeutic Useen_US
dc.subject.meshArthritis - Drug Therapyen_US
dc.subject.meshCyclooxygenase 2en_US
dc.subject.meshCyclooxygenase 2 Inhibitorsen_US
dc.subject.meshCyclooxygenase Inhibitors - Adverse Effects - Therapeutic Useen_US
dc.subject.meshDiclofenac - Adverse Effects - Therapeutic Useen_US
dc.subject.meshDouble-Blind Methoden_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshDuodenal Ulcer - Chemically Induced - Prevention & Controlen_US
dc.subject.meshHelicobacter Pylori - Isolation & Purificationen_US
dc.subject.meshHumansen_US
dc.subject.meshIsoenzymes - Antagonists & Inhibitorsen_US
dc.subject.meshMembrane Proteinsen_US
dc.subject.meshOmeprazole - Therapeutic Useen_US
dc.subject.meshPeptic Ulcer Hemorrhage - Chemically Induced - Prevention & Controlen_US
dc.subject.meshProbabilityen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshProstaglandin-Endoperoxide Synthasesen_US
dc.subject.meshPyrazolesen_US
dc.subject.meshRecurrence - Prevention & Controlen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshStomach Ulcer - Chemically Induced - Prevention & Controlen_US
dc.subject.meshSulfonamides - Adverse Effects - Therapeutic Useen_US
dc.titleCelecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritisen_US
dc.typeArticleen_US
dc.identifier.emailLeung, WK:waikleung@hku.hken_US
dc.identifier.authorityLeung, WK=rp01479en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1056/NEJMoa021907en_US
dc.identifier.pmid12501222-
dc.identifier.scopuseid_2-s2.0-0037180802en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037180802&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume347en_US
dc.identifier.issue26en_US
dc.identifier.spage2104en_US
dc.identifier.epage2110en_US
dc.identifier.isiWOS:000180040900003-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridChan, FKL=7202586434en_US
dc.identifier.scopusauthoridHung, LCT=7103351774en_US
dc.identifier.scopusauthoridSuen, BY=6506058430en_US
dc.identifier.scopusauthoridWu, JCY=7409253910en_US
dc.identifier.scopusauthoridLee, KC=36644184200en_US
dc.identifier.scopusauthoridLeung, VKS=7102336049en_US
dc.identifier.scopusauthoridHui, AJ=7102453674en_US
dc.identifier.scopusauthoridTo, KF=7101911940en_US
dc.identifier.scopusauthoridLeung, WK=7201504523en_US
dc.identifier.scopusauthoridWong, VWS=7202525502en_US
dc.identifier.scopusauthoridChung, SCS=19642462800en_US
dc.identifier.scopusauthoridSung, JJY=35405352400en_US
dc.identifier.citeulike2994399-

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