Two cheers for NSAIDs.
1986; BMJ; Volume: 27; Issue: 11 Linguagem: Inglês
10.1136/gut.27.11.1287
ISSN1468-3288
Autores Tópico(s)Adrenal Hormones and Disorders
ResumoLeading articleTwo cheers for NSAIDsThe non-steroidal anti-inflammatory drugs (NSAIDs) have had a bad press in the past several years.Five new and two old NSAID products have been withdrawn.A spate of recent_publications 1-5 promote the inference, if they do not prove conclusively, 7 that NSAID use increases the risk of gastrointestinal ulceration, bleeding and perforation.This news has had a background obbligato of tsk's, implying that the pharmaceutical industry has spent so much to develop more than two dozen 'me-too' NSAIDs, different chemical species of NSAID that can scarcely be distinguished from one another in controlled clinical trials.To that bleakness, however, it may be useful to add several other perspectives, especially for readers whose specialised focus is on the diseases of the gut.First, and most obvious, is that these drugs offer undeniable benefits to patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and related conditions.This effectiveness is documented in many controlled clinical trials of various sizes, including a recent one with over 2000 patients.8Nevertheless, many arthritic patients are dissatisfied with available NSAID treatment, as evidenced by a great deal of switching from one product to another, and by the fact that there is usually a relative rush to try each new NSAID.On this latter point there hangs a tale, discussed further on.The controlled trials that can scarcely distinguish one NSAID from another aggregate data from dozens, or hundreds of patients who meet the trials' inclusion/exclusion criteria.As Guyatt, Sackett, and colleagues from
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