Impact of NSAID choice and patient symptoms on the cost-effectiveness of strategies to prevent NSAID gastropathy

Am, Fendrick; Bandekar, Rajesh; Me, Chernew; Jm, Scheiman

doi:10.1016/s0016-5085(98)80489-7

Cited by 4 publications

(3 citation statements)

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“…There is also limited safety information for patients with significant hepatic disease. Despite their cost, the use of safer nonsteroidal antiinflammatory drugs can be highly cost effective, particularly in high-risk patients because of the reduction in subsequent overall disease management costs [11]. While long-term studies demonstrating the proven reductions in serious GI complication rates are ongoing, one can anticipate that these agents appear to have disassociated the GI risks of antiinflammatory therapy from their benefits in the management of arthritis and pain.…”

Section: Resultsmentioning

confidence: 99%

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Rofecoxib for the treatment of pain

Scheiman

1999

Curr Treat Options Gastro

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Section: Resultsmentioning

confidence: 99%

“…Theoretical concerns have been raised with regard to COX-2 specific inhibitors leading to increased rates of thromboembolic cardiovascular events. Analysis of the Rofecoxib database demonstrates that these events occurred with equal frequency in the placebo and comparator NSAID group, as were the death rates overall [11].…”

Section: Gi Safetymentioning

confidence: 97%

Rofecoxib for the treatment of pain

Scheiman

1999

Curr Treat Options Gastro

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“…No clear reduction in NSAID-associated dyspeptic symptoms has been seen. Cost-effectiveness Nabumetone may reduce serious adverse events with incremental cost [34]. When targeted to high-risk patients, it may be a highly cost-effective alternative to the combination of more ulcerogenic NSAIDs and co-therapy.…”

Section: Main Drug Interactions None Of Clinical Significancementioning

confidence: 99%

Preventing NSAID toxicity to the upper gastrointestinal tract

Scheiman

1999

Curr Treat Options Gastro

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Prevention of gastrointestinal toxicity begins with the selection of an appropriate analgesic or anti-inflammatory agent. For conditions without inflammation, such as some cases of osteoarthritis, an analgesic with no risk for gastrointestinal toxicity is appropriate. Risk factors for nonsteroidal anti-inflammatory drug (NSAID)-related complications include advanced age; history of ulcer disease or gastrointestinal bleeding; concomitant corticosteroid or anticoagulant use; use of high-dose or multiple NSAIDs; and certain chronic diseases, such as cardiovascular disease. If an NSAID must be used in a patient with risk factors, the patient should receive the lowest-risk NSAID and, in most cases, co-therapy to reduce the risk for NSAID-associated ulcers and their complications. The PGE1 prostaglandin analogue misoprostol is highly efficacious for the prevention of both gastric and duodenal ulcers and has also been shown to reduce the incidence of NSAID-induced ulcer complications. Side effects, such as diarrhea, may limit patient acceptance of the drug. Acid suppression with traditional ulcer-healing doses of H2-blockers significantly reduces rates of duodenal ulcer but is ineffective in reducing gastric ulceration. More potent acid inhibition with double-dose H2-blockers reduces rates of both gastric and duodenal ulcers. Proton-pump inhibitors, such as omeprazole, have been shown to prevent gastric and duodenal ulcers with an efficacy equal to that of misoprostol. They also reduce NSAID-related dyspepsia. Specific cyclooxygenase-2 (COX-2) inhibitors are associated with a markedly reduced rate of endoscopic ulcers. Very high-risk patients who receive these agents may still require co-therapy to prevent complications or reduce dyspepsia. This protocol may be changed by the results of long-term gastrointestinal outcome studies now underway.

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Prospects for changing the burden of nonsteroidal anti-inflammatory drug toxicity11Reprints are not available.

Griffin

Scheiman

2001

The American Journal of Medicine

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Impact of NSAID choice and patient symptoms on the cost-effectiveness of strategies to prevent NSAID gastropathy

Cited by 4 publications

References 0 publications

Rofecoxib for the treatment of pain

Rofecoxib for the treatment of pain

Preventing NSAID toxicity to the upper gastrointestinal tract

Prospects for changing the burden of nonsteroidal anti-inflammatory drug toxicity11Reprints are not available.

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