Understanding NSAID-PPI-COX-2 interrelationships.

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used to treat arthritis but are associated with adverse gastrointestinal events. While the selective COX-2 inhibitors show fewer gastrointestinal complications than NSAIDs, they may not be suitable for all patients and one of them has been associated with serious thrombotic cardiovascular events. Furthermore, many arthritis patients are at high risk of coronary artery disease and take low-dose aspirin, which is also associated with adverse gastrointestinal events. Proton pump inhibitor (PPI) therapy has been shown to be effective in reducing the risk of gastrointestinal complications in this patient population. Recent randomized clinical trials have also shown that pantoprazole therapy is effective in the healing of NSAID-induced gastrointestinal damage. Several studies have also demonstrated that pantoprazole is effective in preventing the development of gastrointestinal lesions in patients with continuous NSAID intake. The use of PPIs in combination with nonselective NSAIDs has also been found to be beneficial in patients at high risk for rebleeding and reduces the incidence of dyspepsia. Finally, the combination of a COX-2 inhibitor with a PPI has shown promise in patients with previous NSAID-related gastrointestinal complications who are at high risk for reinjury. (c) 2004 Prous Science