COX-2 Drugs and GI Bleeding

In Canada, when the Ontario government began paying for a new generation of supposedly safer arthritis drugs, the number of hospital admissions for stomach bleeding rose.

The unexpected finding runs counter to expectations that these widely prescribed drugs, called cyclooxygenase (COX-2) inhibitors, would relieve pain and inflammation with little risk of stomach upset and irritation. This analysis, however, is based on a retrospective look at health data for elderly people rather than on a more rigorous trial.

The COX-2 inhibitors, part of a class of drugs known as NSAIDs, have become blockbusters. For many doctors, managing the risk of stomach bleeding seemed worth the price, as that is a major drawback of the older NSAIDs, such as ibuprofen and aspirin, which sell for pennies a day.

The authors of the Canadian report could not trace each bleeding case to the use of a specific NSAID. Nevertheless, the report suggested that the increased use of COX-2 inhibitors and gastrointestinal (GI) bleeding are directly related.

Researchers believe that the use of COX-2 inhibitors, including rofecoxib (Vioxx®, Merck), drug celecoxib (Celebrex generic (Pfizer), and drug meloxicam (Mobic canadian, Boehringer Ingelheim), has resulted in more stomach bleeding because more patients have been encouraged to use the newer drugs. In fact, a group of 90,000 people who had not been taking any NSAIDs started taking COX-2 drugs after the Ontario government began paying for them. Afterward, hospital admissions for GI bleeding increased by 10% out of a pool of 1.3 million elderly patients in Ontario.

Other factors, such as the increased use of over-the-counter NSAIDs, might explain the study results.