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Cyclooxygenase 2 Selective Agents and Upper Gastrointestinal Disease

Helen Fernandez, MD; Gerson T. Lesser, MD
JAMA. 2000;283(15):1961-1962. doi:10.1001/jama.283.15.1957.
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To the Editor: The study by Dr Simon and colleagues1 appears to provide evidence for the efficacy and safety of celecoxib, a cyclooxygenase 2 (COX-2) inhibitor. However, several aspects of their experimental design appear to limit these conclusions.

First, it is most useful to compare a new agent with the most effective and least toxic existing agent. Although the authors chose naproxen as the comparison drug, other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen2,3 and nabumetone,4 have less gastrointestinal (GI) tract toxicity. Also, they began treatment of the comparison group with 500 mg twice per day of naproxen, which is the maximum suggested initial dosage.5 This is especially troubling because about 40% of this group was older than 60 years and, thus, had a 3-fold risk of NSAID-induced gastropathy.3,6


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