The effect of low-dose aspirin on the decreased risk of development of dyspepsia and gastrointestinal ulcers associated to cyclooxygenase-2 selective inhibitors

Elizabeth Benito-Garcia, Kaleb D Michaud, Frederick Wolfe

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective. To evaluate the risk of gastrointestinal (GI) symptoms and ulcers associated to the use of low-dose aspirin (ASA) among patients with rheumatoid arthritis (RA) and osteoarthritis (OA) treated with cyclooxygenase-2 (COX-2) drugs, to clarify the controversy in the literature. Methods. Using a longitudinal databank, a prospective study using Cox proportional hazards models was performed in patients receiving COX-2 therapy for RA or OA to examine the effect of ASA on GI events. In 4 separate analyses patients reported dyspeptic symptoms and GI ulcers at semiannual intervals for up to 3 years. Ulcers were validated by review of medical records. Results. Among 4240 patients taking COX-2-specific inhibitors, with no ulcer at study start, the age-and sex-adjusted hazard ratios for the effect of ASA on the development of epigastric pain, heartburn, nausea, and ulcers, without these previous events, were 1.11 (95% CI 0.97-1.29), 1.00 (95% CI 0.88-1.15), 1.32 (95% CI 1.13-1.54), and 1.27 (95% CI 0.78-2.05). The use of a propensity score to account for the risk of ASA prescription showed an even lower effect of ASA among all GI variables. This risk occurs within the setting of no prior GI symptoms or GI events, and independently of the use of proton pump inhibitors, other GI drugs, other nonsteroidal antiinflammatory drugs, prednisone, or methotrexate. Conclusion. In actual practice, the use of low-dose ASA has a small effect on the risk of developing dyspeptic symptoms in a group of patients with rheumatic disease.

Original languageEnglish (US)
Pages (from-to)1765-1769
Number of pages5
JournalJournal of Rheumatology
Volume34
Issue number8
StatePublished - Aug 1 2007

Fingerprint

Cyclooxygenase 2 Inhibitors
Dyspepsia
Aspirin
Ulcer
Cyclooxygenase 2
Osteoarthritis
Rheumatoid Arthritis
Gastrointestinal Agents
Heartburn
Propensity Score
Proton Pump Inhibitors
Prednisone
Rheumatic Diseases
Proportional Hazards Models
Methotrexate
Pharmaceutical Preparations
Nausea
Medical Records
Prescriptions
Anti-Inflammatory Agents

Keywords

  • Arthritis
  • Aspirin
  • Gastrointestinal
  • Rheumatic disease
  • Ulcer

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

The effect of low-dose aspirin on the decreased risk of development of dyspepsia and gastrointestinal ulcers associated to cyclooxygenase-2 selective inhibitors. / Benito-Garcia, Elizabeth; Michaud, Kaleb D; Wolfe, Frederick.

In: Journal of Rheumatology, Vol. 34, No. 8, 01.08.2007, p. 1765-1769.

Research output: Contribution to journalArticle

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abstract = "Objective. To evaluate the risk of gastrointestinal (GI) symptoms and ulcers associated to the use of low-dose aspirin (ASA) among patients with rheumatoid arthritis (RA) and osteoarthritis (OA) treated with cyclooxygenase-2 (COX-2) drugs, to clarify the controversy in the literature. Methods. Using a longitudinal databank, a prospective study using Cox proportional hazards models was performed in patients receiving COX-2 therapy for RA or OA to examine the effect of ASA on GI events. In 4 separate analyses patients reported dyspeptic symptoms and GI ulcers at semiannual intervals for up to 3 years. Ulcers were validated by review of medical records. Results. Among 4240 patients taking COX-2-specific inhibitors, with no ulcer at study start, the age-and sex-adjusted hazard ratios for the effect of ASA on the development of epigastric pain, heartburn, nausea, and ulcers, without these previous events, were 1.11 (95{\%} CI 0.97-1.29), 1.00 (95{\%} CI 0.88-1.15), 1.32 (95{\%} CI 1.13-1.54), and 1.27 (95{\%} CI 0.78-2.05). The use of a propensity score to account for the risk of ASA prescription showed an even lower effect of ASA among all GI variables. This risk occurs within the setting of no prior GI symptoms or GI events, and independently of the use of proton pump inhibitors, other GI drugs, other nonsteroidal antiinflammatory drugs, prednisone, or methotrexate. Conclusion. In actual practice, the use of low-dose ASA has a small effect on the risk of developing dyspeptic symptoms in a group of patients with rheumatic disease.",
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