Review article: aspirin, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-1 sparing agents
Article first published online: 26 AUG 2005
Alimentary Pharmacology & Therapeutics Symposium Series
Volume 1, Issue 1, pages 2–5, September 2005
How to Cite
WEAVER, A. L. (2005), Review article: aspirin, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-1 sparing agents. Alimentary Pharmacology & Therapeutics Symposium Series, 1: 2–5. doi: 10.1111/j.1746-6342.2005.00012.x
- Issue published online: 26 AUG 2005
- Article first published online: 26 AUG 2005
Until recently, cyclo-oxygenase-2 inhibitors were one of the mainstays of therapy for patients with osteoarthritis and rheumatoid arthritis because of their improved gastrointestinal safety profile compared with traditional, non-selective non-steroidal anti-inflammatory drugs.
The withdrawal of both rofecoxib and valdecoxib from the market because of concerns about cardiovascular risk has prompted a re-evaluation of treatment choices for arthritis patients who require treatment with non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs, both prescription and over-the-counter, are widely used in the USA. Patients often take several agents concurrently which significantly increases their risk of gastrointestinal adverse events. In addition, many patients also take low-dose aspirin because of its proven beneficial effects in the prevention of cardiovascular events. However, large clinical trials have shown that the concomitant use of aspirin negates the gastrointestinal-sparing effects of selective cyclo-oxygenase-2 inhibitors.
Clinicians need to consider a patient's cardiovascular and gastrointestinal risks when prescribing non-steroidal anti-inflammatory drugs, and in the case of non-selective non-steroidal anti-inflammatory drugs, gastroprotection with an agent such as a proton-pump inhibitor or misoprostol should be considered, particularly in aspirin users.