Risk of upper gastrointestinal events with the use of various NSAIDs: A case-control study in a general population

Objective. The gastrointestinal ( GI) safety of different non-steroidal anti-inflammatory drugs ( NSAIDs) in a real-life setting remains ill defined. The aim of this study was to examine the risk of upper GI events associated with various NSAIDs in a general population. Material and methods. A nationwide, register-based, matched case-control study was carried out in outpatient residents of Finland in 2000 - 04. Cases with upper GI events ( n = 9191) were drawn from the Hospital Discharge Register and individually matched to controls ( n = 41,780) from the Population Register. Results. The semi-selective NSAIDs ( nimesulide, nabumetone, meloxicam, etodolac) had the highest odds ratio for upper GI events even after adjusting for various potential confounders ( adjusted odds ratio ( AOR) 3.63; 95% CI 3.08 - 4.28), followed by non-selective ( 2.98; 2.70 - 3.29) and COX-2 selective NSAIDs (2.53; 2.09 - 3.07). When the current use of semi-selective NSAIDs was compared with that of non-selective and COX-2 selective NSAIDs, the AORs were 1.54 ( 1.13 - 2.09) and 1.67 ( 1.10 - 2.53), respectively. The AORs for the use of COX-2 selective NSAIDs did not differ statistically from the non-selective NSAIDs ( AOR 0.92; 0.65 - 1.31). The AORs for individual NSAIDs varied across and within categories. Conclusions. As a group, the GI safety of the COX-2 selective NSAIDs was not demonstrated as definitively superior to non-selective NSAIDs. Semi-selective NSAIDs do not seem to offer any GI advantage over other NSAIDs.