AJM OnlineClinical research studyComparing Rates of Dyspepsia with Coxibs vs NSAID+PPI: A Meta-Analysis
Section snippets
Search Strategy and Inclusion Criteria
We conducted a structured search of MEDLINE, along with a CD-ROM-assisted (DDW Abstracts-on-Disc; American Gastroenterological Association, Bethesda, Md) review of published abstracts from three major subspecialty journals (American Journal of Gastroenterology, Arthritis and Rheumatism, and Gastroenterology), to identify relevant English-language studies from January 1990 to March 2005. In addition, we reviewed the bibliographies of key review articles for references not captured by our search
Article Selection
The search strategy identified 829 titles (Figure 1). Of these, we selected 32 studies that met our explicit inclusion criteria and reported one or more of our prespecified outcomes (κ > 0.9 for each phase of selection).9, 11, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 There were 42 079 participants in the 32 trials. The reported mean age ranged from 39 to 74 years. The follow-up period ranged from 1 to 72 weeks (mean =
Discussion
Our meta-analysis indicates that the NSAID+PPI combination affords greater risk reduction for dyspeptic symptoms than Coxibs when compared with the common baseline of nonselective NSAIDs. Specifically, compared with a nonselective NSAID, the number needed to treat to prevent one person from developing a dyspeptic symptom is 27 for Coxibs and 11 for the NSAID+PPI combination. Because there are limited head-to-head data comparing Coxibs versus NSAID+PPI therapy, these data provide strong indirect
Conclusion
Our analysis reveals that the NSAID+PPI strategy may be superior to Coxibs in minimizing incident dyspeptic symptoms during the treatment of chronic arthritis. Given the high prevalence and expense of dyspeptic symptoms, our data further the argument that NSAID+PPI therapy may be preferred over Coxibs in the treatment of patients with arthritis at high risk for adverse gastrointestinal events.
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Dr Spiegel is supported by a Veterans Affairs Health Services Research and Development Research Career Development Award. Dr Kanwal is supported by an American Association for the Study of Liver Diseases Advanced Hepatology Fellowship Award. Additional support for this research was provided by a grant from TAP Pharmaceuticals.