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Cyclooxygenase 2 Selective Agents and Upper Gastrointestinal Disease—Reply

Lee S. Simon, MD
JAMA. 2000;283(15):1961-1962. doi:10.1001/jama.283.15.1957.
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In Reply: Drs Fernandez and Lesser are concerned about our inclusion criteria that allowed patients to use concomitant rheumatoid arthritis drugs (eg, glucocorticoids and methotrexate). However, these therapies are included in the standard of care for the treatment of rheumatoid arthritis, and we found that neither glucocorticoid use nor age significantly modified the effects of celecoxib or naproxen on the upper GI tract mucosa. For patients younger than 65 years, the incidence of gastroduodenal ulceration with naproxen was 27% in glucocorticoid users vs 26% in nonusers; in patients aged 65 years or older, the incidence was 36% in glucocorticoid users and 21% in nonusers. These data indicate that the susceptibility for NSAID-induced upper GI tract ulceration is not isolated to a selected subgroup of "at-risk" patients and the clinical benefit of celecoxib appears to extend to all patients similar to those studied.


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