RESEARCH - Celebrex compared with lansoprazole and naproxen to prevent GI ulcer complications

[Guest guest]

Am J Med. 2005 Nov;118(11):1271-8.

Celecoxib compared with lansoprazole and naproxen to prevent

gastrointestinal ulcer complications.

Lai KC, Chu KM, Hui WM, Wong BC, Hu WH, Wong WM, Chan AO, Wong J, Lam SK.

Department of Medicine, The University of Hong Kong, Queen Hospital,

Hong Kong, China. kclai@...

PURPOSE: 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.

PMID: 16271912

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16271912

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org