AGA issues consensus statement on the use of NSAIDs

The American Gastroenterological Association (AGA) has issued a consensus statement on the safe and efficacious use of nonsteroidal anti-inflammatory drugs (NSAIDs), including nonselective, nonsteroidal anti-inflammatory drugs (nsNSAIDs), cyclooxygenase-2 enzyme inhibitors (coxibs), and aspirin (ASA).

The consensus statement, published in Clinical Gastroenterology and Hepatology, is based on recommendations from a multidisciplinary panel of gastroenterologists, rheumatologists, cardiologists, and internists assembled by the AGA.

The authors stressed the need for prescribers to carefully consider both the potential benefits of NSAID use and the risks of gastrointestinal (GI) and/or cardiovascular (CV) toxicity prior to prescribing specific agents or regimens.

The recommendations include: using NSAIDs with lower GI risk (including some nsNSAIDs such as ibuprofen, etodolac, and diclofenac) and coxibs for patients in whom the estimated risk of life-threatening GI complications outweighs the risk of CV events; avoiding coxibs for patients at greater risk of CV events; using low-dose ASA for patients with known CV disease or at high CV risk; limiting dosage and duration of NSAID use and avoiding combination NSAID therapy for all patients, regardless of GI and CV risks; and modifying patient risk factors for GI (through eradicating Heliobacter pylori and considering adding ≥600 mg/d misoprostil or a proton pump inhibitor in patients with a high GI risk) and CV complications (encouraging tobacco cessation and tight control of blood pressure, cholesterol, and diabetes) for all patients.

The panel noted that the concurrent use of ASA with nsNSAIDs might interfere with ASA's CV-protective effects, that ASA may decrease or eliminate the GI benefits of coxib therapy, and that current data do not support the use of buffered or coated ASA to decrease GI toxicity.

The authors stressed the need for additional data from randomized controlled trials "to clarify the relative risks and benefits of nsNSAIDs and coxibs for individual patients."

SOURCE American Gastroenterological Association; Wilcox CM, Allison J, Benzuly K, et al. Consensus development conference on the use of nonsteroidal anti-inflammatory agents, including cyclooxygenase-2 enzyme inhibitors and aspirin. Clin Gastroenterol and Hepatol. 2006;4:1082–1089.