Diclofenac plus proton pump inhibitor quadrupled risk of gastrointestinal damage, study found
THURSDAY, June 17 (HealthDay News) -- Patients who take the painkiller celecoxib for arthritis pain and inflammation are less likely to suffer gastrointestinal damage than those who take diclofenac plus omeprazole, a new study finds.
Celecoxib (Celebrex) is a cox-2 selective non-steroidal anti-inflammatory drug (NSAID), diclofenac (Voltaren) is a non-selective NSAID and omeprazole (Prilosec) is a proton pump inhibitor (PPI).
The study included 4,484 patients in 32 countries or territories who were randomly selected to receive either 200 milligrams (mg) of celecoxib twice a day (2,238 patients) or 75 mg of diclofenac slow-release plus 20 mg of omeprazole (2,246 patients) once a day.
Patients taking diclofenac plus omeprazole were more than four times more likely to suffer upper or lower gastrointestinal damage than celecoxib patients -- 3.8 percent versus 0.9 percent, respectively.
The findings, which were released online June 17 in advance of publication in a future print issue of The Lancet, should prompt a review of approaches used to reduce the risk of NSAID treatment, said the authors of the CONDOR study.
"Since guidelines recommend that selection of NSAID therapy be driven by consideration of both cardiovascular and gastrointestinal effects of treatment, CONDOR has provided new data relevant to patients requiring anti-inflammatory therapy who are at increased gastrointestinal but not increased cardiovascular risk. In this population, the gastrointestinal outcomes of a cox-2 selective NSAID were quite different to those of a non-selective NSAID plus a PPI," Francis Chan of Prince of Wales Hospital, Hong Kong Special Administrative Region, China, and Jay Goldstein of the University of Illinois at Chicago, and colleagues wrote.
"Further understanding of the cardiovascular outcomes of these two strategies requires the results of ongoing trials that have been designed directly to address that important clinical question. The findings of the CONDOR trial should encourage guideline committees to review their treatment recommendations for arthritis patients," the researchers concluded.
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about arthritis.
-- Robert Preidt
SOURCE: The Lancet, news release, June 17, 2010
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