Effect of COX-2 Specific Inhibitor to the Gastric Ulcer Healing in Rheumatoid Arthritis Patients
Angthararak S, Arnantapunpong S*, Chamnongkijpanich K, Cheewasat P, Hrumsam J
Department of Internal Medicine, Rajavithi Hospital
บทคัดย่อ
Background: Peptic Ulcer disease is a common disease among arthritis patients who have regular use of Materials and Methods: receiving non-specific NSAIDs and had at least one gastric ulcer size 3-10 mm. at baseline esophagogastroduodenoscopy (EGD) to receive either lumiracoxib 200 mg/day plus omeprazole 20 mg/day, or placebo plus omeprazole 20 mg/day. After 4 and 8 weeks of treatment, healing of gastric ulcer was reevaluated by EGD. The primary outcome was the percentage of patients in each treatment group who had no gastric ulcers at week 8. This randomized, double-blind, controlled trial included patients who were Results: 200 mg/day plus omeprazole 20 mg/day was 55.6%, and placebo plus omeprazole 20 mg/day was 100% (p =0.228). GU healing rate at week 8 was 100 % in both groups. All treatment was well tolerated and no significant adverse events occurred. A total of 13 patients were randomized to treatment. At week 4, GU healing rate with lumiracoxib Conclusion: week short course, is effective and well-tolerated therapy compared with omeprazole 20 mg/day alone for healing of gastric ulcers in rheumatoid arthritis patient. COX-2 specific inhibitor, lumiracoxib 200 mg/day plus omeprazole 20 mg/day, in a 8 nonsteroidal anti-inflammatory drugs (NSAIDs). In the presence of gastric ulcers, discontinuing NSAIDs may be difficult and not be tolerable for the arthritis patients who depended on these agents for treatment of painful inflammatory joints. Therefore, the ability to heal NSAIDs-associated ulcers while maintaining NSAIDs therapy is an important pharmacologic strategy that has clinical relevance. COX-2 specific inhibitors have more efficacies in minimize GI side effect and ulcer when compared to non-specific COX inhibitor NSAIDs. It’s used may be applicable for selected patient group who need continued use of NSAIDs, but some studies have shown that inhibition of COX-2 resulted in delay healing of ulcer. There were limited data to demonstrate clinically significant delay in gastric healing among arthritis patients who have continued use of NSAIDs. This study was performed to compare the effect of COX-2 specific inhibitor, lumiracoxib (200 mg/day) with standard dose omeprazole and standard dose omeprazole alone for the healing of gastric ulcer (GUs) during 8 weeks in rheumatoid arthritis patients.
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วารสารสมาคมแพทย์ระบบทางเดินอาหารแห่งประเทศไทย ปี 2552, January-April ปีที่: 10 ฉบับที่ 1 หน้า 28-38