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Article: Celecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications
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TitleCelecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications
 
AuthorsLai, KC1 2
Chu, KM1
Hui, WM1
Wong, BCY1
Hu, WHC1
Wong, WM1
Chan, AOO1
Wong, J1
Lam, SK1
 
KeywordsCelecoxib
Lansoprazole
NSAIDs
Ulcers
 
Issue Date2005
 
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
CitationAmerican Journal Of Medicine, 2005, v. 118 n. 11, p. 1271-1278 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.04.031
 
AbstractPURPOSE: Selective cyclooxygenase-2 (COX-2) inhibitors cause significantly fewer peptic ulcers than conventional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at low risk or high risk for peptic ulcers. On the other hand, proton pump inhibitor co-therapy has also been shown to be effective in preventing relapse of peptic ulcers in high-risk patients using nonselective NSAIDs. We compared the efficacy of a selective COX-2 inhibitor with that of proton pump inhibitor co-therapy in the reduction in the incidence of ulcer relapse in patients with a history of NSAID-related peptic ulcers. MATERIALS AND METHODS: For this study, we recruited 224 patients who developed ulcer complications after NSAID use. We excluded patients who required concomitant aspirin treatment and who had renal impairment. After healing of ulcers and eradication of Helicobacter pylori, patients were randomly assigned to treatment with celecoxib 200 mg daily (n = 120) or naproxen 750 mg daily and lansoprazole 30 mg daily (n = 122) for 24 weeks. The primary endpoint was recurrent ulcer complications. RESULTS: During a median follow-up of 24 weeks, 4 (3.7%, 95% confidence interval [CI] 0.0%-7.3%) patients in the celecoxib group, compared with 7 patients (6.3%, 95% CI 1.6%-11.1%) in the lansoprazole group, developed recurrent ulcer complications (absolute difference -2.6%; 95% CI for the difference -9.1%-3.7%). Celecoxib was statistically non-inferior to lansoprazole co-therapy in the prevention of recurrent ulcer complications. Concomitant illness (hazard ratio 4.72, 95% CI 1.24-18.18) and age 65 years or more (hazard ratio 18.52, 95% CI 2.26-142.86) were independent risk factors for ulcer recurrences. Significantly more patients receiving celecoxib (15.0%, 95% CI 9.7-22.5) developed dyspepsia than patients receiving lansoprazole (5.7%, 95% CI 2.8-11.4. P = .02). CONCLUSIONS: Celecoxib was as effective as lansoprazole co-therapy in the prevention of recurrences of ulcer complications in subjects with a history of NSAID-related complicated peptic ulcers. However, celecoxib, similar to lansoprazole co-therapy, was still associated with a significant proportion of ulcer complication recurrences. In addition, more patients receiving celecoxib developed dyspepsia than patients receiving lansoprazole and naproxen. © 2005 Elsevier Inc. All rights reserved.
 
ISSN0002-9343
2013 Impact Factor: 5.302
 
DOIhttp://dx.doi.org/10.1016/j.amjmed.2005.04.031
 
ISI Accession Number IDWOS:000233123000016
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLai, KC
 
dc.contributor.authorChu, KM
 
dc.contributor.authorHui, WM
 
dc.contributor.authorWong, BCY
 
dc.contributor.authorHu, WHC
 
dc.contributor.authorWong, WM
 
dc.contributor.authorChan, AOO
 
dc.contributor.authorWong, J
 
dc.contributor.authorLam, SK
 
dc.date.accessioned2012-09-05T05:25:00Z
 
dc.date.available2012-09-05T05:25:00Z
 
dc.date.issued2005
 
dc.description.abstractPURPOSE: Selective cyclooxygenase-2 (COX-2) inhibitors cause significantly fewer peptic ulcers than conventional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at low risk or high risk for peptic ulcers. On the other hand, proton pump inhibitor co-therapy has also been shown to be effective in preventing relapse of peptic ulcers in high-risk patients using nonselective NSAIDs. We compared the efficacy of a selective COX-2 inhibitor with that of proton pump inhibitor co-therapy in the reduction in the incidence of ulcer relapse in patients with a history of NSAID-related peptic ulcers. MATERIALS AND METHODS: For this study, we recruited 224 patients who developed ulcer complications after NSAID use. We excluded patients who required concomitant aspirin treatment and who had renal impairment. After healing of ulcers and eradication of Helicobacter pylori, patients were randomly assigned to treatment with celecoxib 200 mg daily (n = 120) or naproxen 750 mg daily and lansoprazole 30 mg daily (n = 122) for 24 weeks. The primary endpoint was recurrent ulcer complications. RESULTS: During a median follow-up of 24 weeks, 4 (3.7%, 95% confidence interval [CI] 0.0%-7.3%) patients in the celecoxib group, compared with 7 patients (6.3%, 95% CI 1.6%-11.1%) in the lansoprazole group, developed recurrent ulcer complications (absolute difference -2.6%; 95% CI for the difference -9.1%-3.7%). Celecoxib was statistically non-inferior to lansoprazole co-therapy in the prevention of recurrent ulcer complications. Concomitant illness (hazard ratio 4.72, 95% CI 1.24-18.18) and age 65 years or more (hazard ratio 18.52, 95% CI 2.26-142.86) were independent risk factors for ulcer recurrences. Significantly more patients receiving celecoxib (15.0%, 95% CI 9.7-22.5) developed dyspepsia than patients receiving lansoprazole (5.7%, 95% CI 2.8-11.4. P = .02). CONCLUSIONS: Celecoxib was as effective as lansoprazole co-therapy in the prevention of recurrences of ulcer complications in subjects with a history of NSAID-related complicated peptic ulcers. However, celecoxib, similar to lansoprazole co-therapy, was still associated with a significant proportion of ulcer complication recurrences. In addition, more patients receiving celecoxib developed dyspepsia than patients receiving lansoprazole and naproxen. © 2005 Elsevier Inc. All rights reserved.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationAmerican Journal Of Medicine, 2005, v. 118 n. 11, p. 1271-1278 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.04.031
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.amjmed.2005.04.031
 
dc.identifier.epage1278
 
dc.identifier.hkuros111296
 
dc.identifier.isiWOS:000233123000016
 
dc.identifier.issn0002-9343
2013 Impact Factor: 5.302
 
dc.identifier.issue11
 
dc.identifier.pmid16271912
 
dc.identifier.scopuseid_2-s2.0-27644531878
 
dc.identifier.spage1271
 
dc.identifier.urihttp://hdl.handle.net/10722/162897
 
dc.identifier.volume118
 
dc.languageeng
 
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAmerican Journal of Medicine
 
dc.relation.referencesReferences in Scopus
 
dc.subject.mesh2-Pyridinylmethylsulfinylbenzimidazoles
 
dc.subject.meshAdult
 
dc.subject.meshAged
 
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal - Administration & Dosage - Adverse Effects - Therapeutic Use
 
dc.subject.meshAnti-Ulcer Agents - Administration & Dosage - Therapeutic Use
 
dc.subject.meshCyclooxygenase 2 Inhibitors - Adverse Effects - Therapeutic Use
 
dc.subject.meshDrug Therapy, Combination
 
dc.subject.meshDyspepsia - Chemically Induced
 
dc.subject.meshFemale
 
dc.subject.meshFollow-Up Studies
 
dc.subject.meshHelicobacter Infections - Drug Therapy
 
dc.subject.meshHelicobacter Pylori
 
dc.subject.meshHumans
 
dc.subject.meshIncidence
 
dc.subject.meshMale
 
dc.subject.meshMiddle Aged
 
dc.subject.meshNaproxen - Administration & Dosage - Adverse Effects - Therapeutic Use
 
dc.subject.meshOmeprazole - Administration & Dosage - Analogs & Derivatives - Therapeutic Use
 
dc.subject.meshPeptic Ulcer - Chemically Induced - Epidemiology - Prevention & Control
 
dc.subject.meshPeptic Ulcer Hemorrhage - Chemically Induced
 
dc.subject.meshProspective Studies
 
dc.subject.meshProton Pumps - Antagonists & Inhibitors
 
dc.subject.meshPyrazoles - Adverse Effects - Therapeutic Use
 
dc.subject.meshRecurrence
 
dc.subject.meshRisk Factors
 
dc.subject.meshSulfonamides - Adverse Effects - Therapeutic Use
 
dc.subject.meshTreatment Outcome
 
dc.subjectCelecoxib
 
dc.subjectLansoprazole
 
dc.subjectNSAIDs
 
dc.subjectUlcers
 
dc.titleCelecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications
 
dc.typeArticle
 
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<contributor.author>Hui, WM</contributor.author>
<contributor.author>Wong, BCY</contributor.author>
<contributor.author>Hu, WHC</contributor.author>
<contributor.author>Wong, WM</contributor.author>
<contributor.author>Chan, AOO</contributor.author>
<contributor.author>Wong, J</contributor.author>
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<description.abstract>PURPOSE: Selective cyclooxygenase-2 (COX-2) inhibitors cause significantly fewer peptic ulcers than conventional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at low risk or high risk for peptic ulcers. On the other hand, proton pump inhibitor co-therapy has also been shown to be effective in preventing relapse of peptic ulcers in high-risk patients using nonselective NSAIDs. We compared the efficacy of a selective COX-2 inhibitor with that of proton pump inhibitor co-therapy in the reduction in the incidence of ulcer relapse in patients with a history of NSAID-related peptic ulcers. MATERIALS AND METHODS: For this study, we recruited 224 patients who developed ulcer complications after NSAID use. We excluded patients who required concomitant aspirin treatment and who had renal impairment. After healing of ulcers and eradication of Helicobacter pylori, patients were randomly assigned to treatment with celecoxib 200 mg daily (n = 120) or naproxen 750 mg daily and lansoprazole 30 mg daily (n = 122) for 24 weeks. The primary endpoint was recurrent ulcer complications. RESULTS: During a median follow-up of 24 weeks, 4 (3.7%, 95% confidence interval [CI] 0.0%-7.3%) patients in the celecoxib group, compared with 7 patients (6.3%, 95% CI 1.6%-11.1%) in the lansoprazole group, developed recurrent ulcer complications (absolute difference -2.6%; 95% CI for the difference -9.1%-3.7%). Celecoxib was statistically non-inferior to lansoprazole co-therapy in the prevention of recurrent ulcer complications. Concomitant illness (hazard ratio 4.72, 95% CI 1.24-18.18) and age 65 years or more (hazard ratio 18.52, 95% CI 2.26-142.86) were independent risk factors for ulcer recurrences. Significantly more patients receiving celecoxib (15.0%, 95% CI 9.7-22.5) developed dyspepsia than patients receiving lansoprazole (5.7%, 95% CI 2.8-11.4. P = .02). CONCLUSIONS: Celecoxib was as effective as lansoprazole co-therapy in the prevention of recurrences of ulcer complications in subjects with a history of NSAID-related complicated peptic ulcers. However, celecoxib, similar to lansoprazole co-therapy, was still associated with a significant proportion of ulcer complication recurrences. In addition, more patients receiving celecoxib developed dyspepsia than patients receiving lansoprazole and naproxen. &#169; 2005 Elsevier Inc. All rights reserved.</description.abstract>
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<subject>Celecoxib</subject>
<subject>Lansoprazole</subject>
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<subject.mesh>Sulfonamides - Adverse Effects - Therapeutic Use</subject.mesh>
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong