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BMJ (Clinical Research Ed.) Jun 1996To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs.
DESIGN
Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation.
SETTING
Hospital and community based case-control and cohort studies.
MAIN OUTCOME MEASURES
(a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies.
RESULTS
12 studies met the inclusion criteria. 11 provided comparative data on ibuprofen and other drugs. Ibuprofen ranked lowest or equal lowest for risk in 10 of the 11 studies. Pooled relative risks calculated with exposure to ibuprofen used as reference were all significantly greater than 1.0 (interval of point estimates 1.6 to 9.2). Overall, ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those with naproxen and indomethacin.
CONCLUSIONS
The low risk of serious gastrointestinal complications with ibuprofen seems to be attributable mainly to the low doses of the drug used in clinical practice. In higher doses ibuprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs. Use of low risk drugs in low dosage as first line treatment would substantially reduce the morbidity and mortality due to serious gastrointestinal toxicity from these drugs.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Cohort Studies; Dose-Response Relationship, Drug; Gastrointestinal Hemorrhage; Hospitalization; Humans; Ibuprofen; Intestinal Perforation; Risk
PubMed: 8664664
DOI: 10.1136/bmj.312.7046.1563 -
Zhonghua Nei Ke Za Zhi Jan 2004To assess whether or not non-steroidal anti-inflammatory agents (NSAIDs) might prevent colorectal polyps. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To assess whether or not non-steroidal anti-inflammatory agents (NSAIDs) might prevent colorectal polyps.
METHODS
A systematic review of all relevant randomized controlled trials was performed. We searched all randomized controlled trials of chemoprevention of colorectal polyps. Abstracts was included.
RESULTS
8 trials were assessed in the final systematic analysis. We found a sufficient evidence to support that aspirin might prevent the development of colorectal adenomas in comparing with placebo group in two trails of high quality and large sample (P = 0.003). However, there is no evidence to support that sulindac and celecoxib might cure or prevent colorectal adenomas or familial adenomatous polyposis (P > 0.05) and also no evidence to support that dosage of NSAIDs is related with the result of prevention of colorectal adenomas. It was shown that regular aspirin use for 30-60 months cannot reduce the risk of colorectal cancer (P = 0.8). No significant difference in the number of adverse events was found between patients taking NSAIDs and those given placebo (P = 0.9).
CONCLUSIONS
Aspirin might prevent the development of colorectal adenomas, but there is no evidence to support that sulindac and celecoxib might cure or prevent colorectal adenomas or familial adenomatous polyposis and that regular aspirin use might reduce the risk of colorectal cancer.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Chemoprevention; Colonic Polyps; Humans; PubMed; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 14990012
DOI: No ID Found -
The Annals of Pharmacotherapy May 2006Nonsteroidal antiinflammatory drugs (NSAIDs) are increasingly being used during pregnancy to treat a variety of conditions. An evaluation of the risk of premature... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nonsteroidal antiinflammatory drugs (NSAIDs) are increasingly being used during pregnancy to treat a variety of conditions. An evaluation of the risk of premature closure of the ductus arteriosus is useful in determining the safety of NSAIDs at different stages of pregnancy.
OBJECTIVE
To determine whether NSAID use during the third trimester of pregnancy is associated with an increased risk of premature constriction of the ductus arteriosus.
METHODS
A systematic review was conducted of MEDLINE (1966-2004), Embase (1980-2004), and the Cochrane Database of Systematic Reviews (1991-2004). Summary estimates of the odds ratios, comparing ductal outcomes in exposed and unexposed fetuses, and their 95% confidence intervals were calculated assuming a random effects model.
RESULTS
Based on 217 patients exposed to indomethacin and 221 to placebo, the risk of ductal closure was 15-fold higher in the group of women exposed to NSAIDs compared with those receiving either placebo or other NSAIDs (8 studies; OR = 15.04, 95% CI 3.29 to 68.68). There was no significant increased risk of ductal closure in the infants of women treated with indomethacin compared with those receiving other drugs (4 studies; OR = 2.12, 95% CI 0.48 to 9.25). Similar results were found when calculating rate differences.
CONCLUSIONS
Short-term use of NSAIDs in late pregnancy is associated with a significant increase in the risk of premature ductal closure.
Topics: Abnormalities, Drug-Induced; Anti-Inflammatory Agents, Non-Steroidal; Ductus Arteriosus; Female; Humans; Indomethacin; Pregnancy; Pregnancy Trimester, Third; Randomized Controlled Trials as Topic; Sulindac
PubMed: 16638921
DOI: 10.1345/aph.1G428