David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Yuan JQ et al. Aliment Pharmacol Ther 2016 Aug 17.

The protective effect of coxibs against bleeding, obstruction, or perforation was lessened but not eliminated with concomitant low-dose aspirin use.

Coxibs are associated with a lower risk for gastrointestinal (GI) adverse events compared with nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs). It has been suggested that concomitant use of aspirin mitigates this benefit.

In a meta-analysis of data from 84,150 patients participating in 11 trials, investigators compared risks for complicated GI events (bleeding, obstruction, perforation) and clinical events (complicated events plus symptomatic ulcers) between coxib users and nsNSAID users across subgroups of low-dose aspirin users and nonusers.

Results were as follows:

Risk for complications was lower with coxibs versus nsNSAIDs (relative risk, 0.54), but concomitant aspirin use eliminated this risk reduction (RR, 0.90); in aspirin nonusers, risk was further reduced (RR, 0.33).

The number needed to treat (NNT) to prevent one complication in aspirin nonusers was 115.

Risk for clinical events was also reduced with coxibs versus nsNSAIDs (RR 0.59), though less so with aspirin use (RRs, 0.77 with aspirin and 0.50 without).

The NNT for clinical events was 72 with aspirin and 69 without aspirin.

Risks for symptomatic ulcers and endoscopic ulcers (RRs, 0.60 and 0.29, respectively) were lower with coxibs compared with nsNSAIDs; aspirin use mitigated the risk benefit for endoscopic ulcers but not symptomatic ulcers.

The NNT to prevent one endoscopic ulcer was 6 for aspirin users and 5 for nonusers.

CITATION(S):

Yuan JQ et al. Systematic review with meta-analysis: The gastrointestinal benefits of COX-2 selective inhibitors with concomitant use of low-dose aspirin. Aliment Pharmacol Ther 2016 Aug 17; [e-pub]. 

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