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
2011 Impact Factor: 5.43
2011 SCImago Journal Rankings: 0.364
DOIhttp://dx.doi.org/10.1016/j.amjmed.2005.04.031
ReferencesReferences in Scopus
DC Field
Value
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.issn0002-9343
2011 Impact Factor: 5.43
2011 SCImago Journal Rankings: 0.364
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
Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong