Cox-2 Use Is Down, but Ulcers Are Up
Patients Turn to Traditional NSAID Painkillers but Skip Drugs That Protect Their Stomachs
WebMD News Archive
Nov. 8, 2007 (Boston) -- The number of bleeding ulcers and other
gastrointestinal complications has increased since a class of pain drugs called
Cox-2 inhibitors fell out of favor due to their increased risk of heart attack or stroke, according to a new
The new research was presented Thursday at the American College of
Rheumatology Annual Scientific Meeting in Boston.
Cox-2 inhibitors are a type of nonsteroidal anti-inflammatory drug (NSAID).
They were developed to be safer on the stomach than traditional NSAIDs such as ibuprofen and naproxen. But research linking
Cox-2 drugs to heart attack and stroke resulted in the withdrawal of some Cox-2
drugs from the market and a decline in the use of these drugs among people with
Many people returned to using traditional NSAIDs, which may be safer on the
heart but are harsher on the stomach, without taking other drugs known to
protect the stomach.
"An increasing number of elderly users of NSAIDs are again being left
without appropriate gastroprotection resulting in an impending public health
disaster," says researcher Gurkirpal Singh, MD, professor of medicine,
immunology, and rheumatology at Stanford University Medical School in Palo
Alto, Calif. "Patients need to talk to their doctors to make sure they are
Some people with arthritis who take traditional NSAIDs and are considered to
be at risk of GI side effects should take proton pump inhibitors (PPI) to
reduce acid production in the stomach, or misoprostol, which protects the
The problem is that not enough people are doing this, says Singh.
"PPI use did triple, but even then the Cox-2 drop was so huge that a lot
of people were left unprotected," he tells WebMD.
The new study included arthritis patients older than 65 who were treated
with NSAIDs for at least 30 days from 1997 to 2005. The researchers analyzed
more than 4 million prescriptions for NSAIDs in the study and tracked the rate
of hospitalizations and/or emergency room visits for complicated ulcers of the
stomach and small intestine per 100,000 prescriptions.
Increase in Ulcers in 2005
While the gastroprotection gap (the number of people not protecting their
stomachs when taking traditional NSAIDs) had been declining steadily over the
last decade, it more than doubled in 2005, reaching approximately 35%, the
The Cox-2 drug Vioxx was pulled from the market in September 2004 by its
manufacturer. The FDA called for the withdrawal of a second Cox-2 drug, Bextra,
There was a corresponding 21% increase in serious GI complications in 2005,
the study found.
"Gastrointestinal bleeds are still an important side effect, and we need
to be aware of this because we took our eyes off the ball and look what
happened," Singh tells WebMD.