NSAIDs, Selective COX-2 Inhibitors, and PPIs: What's the Best Combination to Reduce PUB?

Use of a COX-2 inhibitor with a proton-pump inhibitor was the most effective alternative to nonselective nonsteroidal anti-inflammatory drug use alone in reducing bleeding risk.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with peptic ulcer bleeding (PUB). This risk may be decreased but not eliminated by using selective COX-2 inhibitors. Concomitant proton-pump inhibitor (PPI) therapy reduces the risk in both situations.

In a population-based case-control study, Dutch researchers compared PUB risks among subgroups of patients currently using nonselective NSAIDs (nsNSAIDs) or COX-2 inhibitors (but not both) with or without PPIs. Cases were 2634 patients hospitalized for PUB and were matched by birth year and sex with 5074 control patients without PUB.

Compared with users of nsNSAIDs alone, patients using both a COX-2 inhibitor and a PPI had the lowest relative risk for PUB (adjusted odds ratio, 0.51). …

Reviewing Author

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Disclosures

Nothing to disclose

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Disclosures

Nothing to disclose

NSAIDs, Selective COX-2 Inhibitors, and PPIs: What's the Best Combination to Reduce PUB?

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Reviewing Author