Goldstein JL et al. (2004) Reduced incidence of upper gastrointestinal ulcer complications with the COX-2 selective inhibitor, valdecoxib. Aliment Pharmacol Ther 20: 527–538

Nonselective NSAIDs are often prescribed for patients with osteoarthritis (OA) and adult onset rheumatoid arthritis (RA). Their long-term use, however, is associated with an increased risk of ulcer complications, possibly resulting from COX-1 inhibition in the gastric mucosa. In addition, these agents inhibit platelet aggregation and so might increase the risk of bleeding. These problems may be overcome using COX-2-selective inhibitors, which are equally as effective as nonselective NSAIDs in treating arthritis pain. Goldstein et al. have assessed the incidence of upper gastrointestinal complications in patients treated with the COX-2-selective inhibitor, valdecoxib.

The authors carried out a predefined, pooled analysis of eight randomized, controlled trials (RCTs) and three long-term, open-label safety trials of valdecoxib in OA and RA. In each trial, the incidence of upper gastrointestinal ulcer complications was assessed according to a priori definitions. The RCTs included 7,434 patients treated for 12–26 weeks with valdecoxib (5–80 mg daily), a nonselective NSAID, or placebo. The open-label studies included 2,871 patients receiving valdecoxib (10–80 mg daily) for up to 1 year.

There was a low rate of upper gastrointestinal ulcer complications among patients treated with valdecoxib in the RCTs (0.68%) and the open-label studies (0.39%). The rate was approximately three-fold higher (1.96%) in patients receiving nonselective NSAIDs (P = 0.018). The difference was more pronounced when non-aspirin users were analyzed separately.

The authors conclude that valdecoxib may therefore be more appropriate than NSAIDs in the long-term treatment of arthritis symptoms.