Combination therapy versus celecoxib, a single selective COX-2 agent, to reduce gastrointestinal toxicity in arthritic patients: patient and cost-effectiveness considerations

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating symptoms of rheumatologic diseases, such as osteoarthritis and rheumatoid arthritis. Knowing their side effects and the way to minimize them is a medical responsibility. To reduce NSAID-related risk, clinicians should choose a gastroprotective strategy. This may include coprescribing a traditional NSAID with a proton pump inhibitor or a high-dose histamine 2-receptor antagonist (H₂RA), or using a cyclo-oxygenase (COX)-2 selective inhibitor or a COX-2 with a proton pump inhibitor. Assessing each patient’s risk (cardiovascular and gastrointestinal) is a priority in order to decide the best intervention to minimize toxicity. In this article, we review some of the common interventions for reducing the gastrointestinal side effects of NSAIDs.

Keywords:

• arthritis
• osteoarthritis
• celecoxib
• nonsteroidal anti-inflammatory drugs
• gastrointestinal toxicity
• cost-effectiveness

Acknowledgments

The authors gratefully acknowledge the advice of Catoggio LJ, MD, and Soriano ER, MD, Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires.

Disclosure

The authors report no conflicts of interest in this work.