Non-steroidal anti-inflammatory drugs
| Autor: | H. Ferguson, T. C K Tham, P. C Gotzsche |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
medicine.medical_specialty
business.industry Anti-ulcer Agent Perforation (oil well) General Engineering Gastric outlet obstruction General Medicine medicine.disease Placebo Surgery Ranitidine medicine General Earth and Planetary Sciences Adverse effect business Intensive care medicine Misoprostol Omeprazole General Environmental Science medicine.drug |
| Zdroj: | BMJ. 321:568-568 |
| ISSN: | 1468-5833 0959-8138 |
| DOI: | 10.1136/bmj.321.7260.568 |
| Popis: | Editor—Gotzsche's review on non-steroidal anti-inflammatory drugs contains some inconsistencies that we would like to highlight.1 In the summary section on interventions Gotzsche states that H2 blockers are likely to be beneficial in high risk patients who cannot avoid non-steroidal anti-inflammatory drugs, albeit to a lesser extent than omeprazole. This statement is misleading and contradicts the clinical evidence presented later in the review. The author describes two randomised controlled trials comparing ranitidine with omeprazole2 and misoprostol.3 The results of these trials showed that ranitidine was inferior to both of these drugs in reducing ulcers induced by non-steroidal anti-inflammatory drugs. A systematic review quoted by Gotzsche showed that H2 blockers did not reduce the risk of gastric ulcer induced by non-steroidal anti-inflammatory drugs although they did reduce the risk of duodenal ulcer.4 From the evidence, H2 blockers do not seem to be beneficial for high risk patients who cannot avoid non-steroidal anti-inflammatory drugs. In his comment on the effects of cotreatments to reduce the risk of gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs Gotzsche states that the clinical relevance of the randomised controlled trials that he describes is doubtful. He contradicts himself by stating that the trial that used clinically relevant outcomes such as perforation, gastric outlet obstruction, or bleeding found a significant reduction in these outcomes with misoprostol compared with placebo in high risk patients (age >75; history of peptic ulcer, bleeding, or cardiovascular disease).5 In other words, patients at high risk of complications induced by non-steroidal anti-inflammatory drugs would seem to benefit from active cotreatment. The inconsistencies in this review should be clarified. H2 blockers are unlikely to be of benefit in high risk patients who cannot avoid non-steroidal anti-inflammatory drugs. Cotreatment to reduce the risk of gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs does seem to be beneficial in high risk patients and so is surely clinically relevant. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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