Abstract
Highly selective inhibitors of cyclooxygenase-2 (COX-2i) were introduced to minimize peptic ulcers and their complications caused by dual COX inhibitors (COXi). Co-prescribing a (generally cheap) dual COXi with a gastroprotectant is an alternative strategy, proven to reduce the incidence of NSAID-associated endoscopic ulcers. This review compares the efficacies of these two strategies and makes some estimates of their relative cost-effectiveness. In standard risk patients, endoscopic ulcers are reduced to about the same extent (around 70-80%) by either co-prescribing omeprazole or lansoprazole with a dual COXi or preferring a COX-2i alone. COX-2i reduced ulcer complications by a weighted mean of around 60% in comparative studies with dual COXi. There is little information about the influence of PPI on this endpoint, although one study using H. pylori treatment as a possible surrogate for placebo intervention found 77% protection against recurrent upper gastrointestinal bleeding by co-administered omeprazole. One direct comparison of the two strategies in high-risk patients (recent ulcer bleed) found quite high rates of re-presentation with bleeding ulcer using either strategy, and the differences between them were not significant. Drug costs in four Western countries were compared for each strategy. In one, the costs were similar, but in the others the combination of a cheap dual COXi with omeprazole was usually more expensive than using a COX-2i. The safest strategy in highest risk patients may be to coprescribe a gastroprotectant with a COX-2i, with resulting higher drug costs but possibly offset by savings in other health costs. The efficacy and cost-benefit of this alternative approach warrants investigation.
Keywords: nsaids, cox-2 inhibitors, peptic ulcer, ulcer hemorrhage, proton pump inhibitors, histamine h2-receptor antagonists, misoprostol, cost-effectiveness
Current Pharmaceutical Design
Title: COX-2 Inhibition Versus Gastroprotection with Dual COX Inhibitors: An Evidence-Based Approach
Volume: 9 Issue: 27
Author(s): Alexander J.V. Thompson and Neville D. Yeomans
Affiliation:
Keywords: nsaids, cox-2 inhibitors, peptic ulcer, ulcer hemorrhage, proton pump inhibitors, histamine h2-receptor antagonists, misoprostol, cost-effectiveness
Abstract: Highly selective inhibitors of cyclooxygenase-2 (COX-2i) were introduced to minimize peptic ulcers and their complications caused by dual COX inhibitors (COXi). Co-prescribing a (generally cheap) dual COXi with a gastroprotectant is an alternative strategy, proven to reduce the incidence of NSAID-associated endoscopic ulcers. This review compares the efficacies of these two strategies and makes some estimates of their relative cost-effectiveness. In standard risk patients, endoscopic ulcers are reduced to about the same extent (around 70-80%) by either co-prescribing omeprazole or lansoprazole with a dual COXi or preferring a COX-2i alone. COX-2i reduced ulcer complications by a weighted mean of around 60% in comparative studies with dual COXi. There is little information about the influence of PPI on this endpoint, although one study using H. pylori treatment as a possible surrogate for placebo intervention found 77% protection against recurrent upper gastrointestinal bleeding by co-administered omeprazole. One direct comparison of the two strategies in high-risk patients (recent ulcer bleed) found quite high rates of re-presentation with bleeding ulcer using either strategy, and the differences between them were not significant. Drug costs in four Western countries were compared for each strategy. In one, the costs were similar, but in the others the combination of a cheap dual COXi with omeprazole was usually more expensive than using a COX-2i. The safest strategy in highest risk patients may be to coprescribe a gastroprotectant with a COX-2i, with resulting higher drug costs but possibly offset by savings in other health costs. The efficacy and cost-benefit of this alternative approach warrants investigation.
Export Options
About this article
Cite this article as:
Thompson J.V. Alexander and Yeomans D. Neville, COX-2 Inhibition Versus Gastroprotection with Dual COX Inhibitors: An Evidence-Based Approach, Current Pharmaceutical Design 2003; 9 (27) . https://dx.doi.org/10.2174/1381612033453956
DOI https://dx.doi.org/10.2174/1381612033453956 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Medicinal Properties of the Jamaican Pepper Plant Pimenta dioica and Allspice
Current Drug Targets Susceptibility of Periodontopathogenic and Cariogenic Bacteria to Defensins and Potential Therapeutic Use of Defensins in Oral Diseases
Current Pharmaceutical Design The Promotional Effect of Mesenchymal Stem Cell Homing on Bone Tissue Regeneration
Current Stem Cell Research & Therapy PEDF in Angiogenic Eye Diseases
Current Molecular Medicine Transforming Growth Factor-β, Cell Signaling and Cardiovascular Disorders
Current Vascular Pharmacology Subject Index To Volume 6
Current Gene Therapy Polyethylenimine In Medicinal Chemistry
Current Medicinal Chemistry Taking a Systems Approach to the Identification of Novel Therapeutic Targets and Biomarkers
Current Pharmaceutical Biotechnology Epidemiology and Pathophysiology of Chronic Cough
Current Respiratory Medicine Reviews Cyclophilins in Atherosclerosis: A New Therapeutic Target?
Current Pharmaceutical Design Recent Patents in Toll-like Receptor Pathways and Relevance to Cancer
Recent Patents on Anti-Cancer Drug Discovery Development and Characterization of Spray Dried Microparticles for Pulmonary Delivery of Antifungal Drug
Current Drug Delivery Pediatrics for Disability: A Comprehensive Approach to Children with Syndromic Psychomotor Delay
Current Pediatric Reviews Do Epigenetic Pathways Initiate Late Onset Alzheimer Disease (LOAD): Towards a New Paradigm
Current Alzheimer Research Towards Isozyme-Selective HDAC Inhibitors For Interrogating Disease
Current Topics in Medicinal Chemistry Plant-Derived Products as Antibacterial and Antifungal Agents in Human Health Care
Current Medicinal Chemistry A Review on Genus Alseodaphne: Phytochemistry and Pharmacology
Mini-Reviews in Organic Chemistry Assessment of Possible Drug Interactions in Patients with Psoriasis and Associated Comorbid Medical Conditions: An Observational Study
Reviews on Recent Clinical Trials Platelet-neutrophil Interactions as a Target for Prevention and Treatment of Transfusion- related Acute Lung Injury
Current Pharmaceutical Design New Insights into the Biology of 1-Antitrypsin and its Role in Chronic Obstructive Pulmonary Disease
Current Respiratory Medicine Reviews