Celecoxib and NSAID-Induced Complications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medications in the world; their major side effect is gastrointestinal complications. Cyclooxygenase-2 (COX-2)-selective NSAIDs cause fewer endoscopic ulcers than do nonselective NSAIDs, but data on significant complications (bleeding, perforation, or gastric obstruction) are lacking. In this U.S. and Canadian study, 8059 patients with osteoarthritis or rheumatoid arthritis were randomized to receive either the COX-2-selective NSAID celecoxib (400 mg twice daily) or a conventional NSAID (ibuprofen or diclofenac); 4573 patients were followed for 6 months. In addition, low-dose aspirin was used by 20 percent of participants.

Overall, the incidence of upper GI ulcer complic…