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Pain Management Health Center

Cox-2 Use Is Down, but Ulcers Are Up

Patients Turn to Traditional NSAID Painkillers but Skip Drugs That Protect Their Stomachs
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WebMD Health News
Reviewed by Louise Chang, MD

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 study.

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 arthritis.

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 protected."

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 stomach lining.

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 study shows.

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