COX-1 Vs COX-2 inhibitors (relative risk of GI side effects)

A MeReC review stated that (1)

• • cox-2 inhibitors, as a class, are associated with a lower GI risk than traditional NSAIDs. However, their GI-safety advantage is diminished when co-administered with aspirin
  • of the traditional NSAIDS, low-dose ibuprofen is associated with a lower GI risk than diclofenac and naproxen
  • use of a proton pump inhibitor (PPI) with any NSAID significantly reduces the risk of GI side effects
  • benefits from gastroprotection largely depend on the baseline risk that the individual has for GI complications. There is, as yet, very little direct evidence that adding a PPI to a cox-2 inhibitor is more beneficial than adding a PPI to a traditional NSAID

Note - like all NSAIDs, celecoxib also carries an additional warning for gastrointestinal (GI) effects, including bleeding, ulceration, and perforation of the stomach and intestines. This adverse effect makes it particularly dangerous to susceptible populations such as older patients. (2)

Reference:

1. MeReC Extra 2007;30.
2. García-Rayado G, Navarro M, Lanas A. NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs. Expert Rev Clin Pharmacol. 2018 Oct;11(10):1031-1043.