PMID- 16651060
OWN - NLM
STAT- MEDLINE
DCOM- 20060516
LR  - 20181201
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 119
IP  - 5
DP  - 2006 May
TI  - Comparing rates of dyspepsia with Coxibs vs NSAID+PPI: a meta-analysis.
PG  - 448.e27-36
AB  - PURPOSE: Because dyspeptic symptoms are far more prevalent than ulcer 
      complications in users of nonsteroidal anti-inflammatory drugs (NSAIDs), economic 
      models indicate that dyspepsia rates (not ulcer complications) are the major 
      determinant of cost-effectiveness in treating arthritis. We performed a 
      meta-analysis to compare rates of dyspepsia for two common therapies in high-risk 
      patients with arthritis: cyclooxygenase-2 inhibitor (Coxib) alone and combination 
      therapy with a nonselective NSAID and a proton pump inhibitor (PPI) (NSAID+PPI). 
      METHODS: We performed a systematic review to identify trials comparing either a 
      Coxib versus NSAID or NSAID+PPI versus NSAID in chronic arthritis. We selected 
      studies that report incident dyspepsia, defined a priori as "epigastric pain," 
      "dyspepsia," and "nausea." We then performed meta-analysis to compare the 
      relative risk reduction and absolute risk reduction of dyspepsia for Coxib versus 
      NSAID and NSAID+PPI versus NSAID. RESULTS: Meta-analysis of 26 studies comparing 
      dyspepsia between Coxibs and NSAIDs revealed a 12% relative risk reduction for 
      Coxibs with an absolute risk reduction of 3.7%. Meta-analysis of four studies 
      comparing dyspepsia between the NSAID+PPI combination and NSAIDs alone revealed a 
      66% relative risk reduction for NSAID+PPI with an absolute risk reduction of 9%. 
      Compared with the NSAID strategy, the number needed to treat to prevent dyspepsia 
      was 27 for Coxibs and 11 for NSAID+PPI. CONCLUSION: NSAID+PPI affords greater 
      risk reduction for dyspepsia than Coxibs when compared with the common baseline 
      of NSAIDs. Because there are limited head-to-head data comparing Coxibs versus 
      NSAID+PPI, these data provide the best indirect evidence that NSAID+PPI may be 
      superior to Coxibs in minimizing incident dyspepsia.
FAU - Spiegel, Brennan M R
AU  - Spiegel BM
AD  - Division of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles 
      Healthcare System, Los Angeles, Calif 90073, USA. bspiegel@mednet.ucla.edu
FAU - Farid, Mary
AU  - Farid M
FAU - Dulai, Gareth S
AU  - Dulai GS
FAU - Gralnek, Ian M
AU  - Gralnek IM
FAU - Kanwal, Fasiha
AU  - Kanwal F
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PT  - Systematic Review
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Cyclooxygenase 2 Inhibitors)
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use
MH  - Arthritis/drug therapy
MH  - Cyclooxygenase 2 Inhibitors/*adverse effects/therapeutic use
MH  - Drug Therapy, Combination
MH  - Dyspepsia/*chemically induced/epidemiology
MH  - Enzyme Inhibitors/*adverse effects/therapeutic use
MH  - Humans
MH  - Incidence
MH  - *Proton Pump Inhibitors
MH  - Risk Factors
EDAT- 2006/05/03 09:00
MHDA- 2006/05/17 09:00
CRDT- 2006/05/03 09:00
PHST- 2005/09/06 00:00 [received]
PHST- 2005/11/20 00:00 [revised]
PHST- 2005/11/21 00:00 [accepted]
PHST- 2006/05/03 09:00 [pubmed]
PHST- 2006/05/17 09:00 [medline]
PHST- 2006/05/03 09:00 [entrez]
AID - S0002-9343(05)01139-3 [pii]
AID - 10.1016/j.amjmed.2005.11.020 [doi]
PST - ppublish
SO  - Am J Med. 2006 May;119(5):448.e27-36. doi: 10.1016/j.amjmed.2005.11.020.