Incidence of gastroduodenal ulcers during treatment with celecoxib or diclofenac:
pooled results from three 12-week trials in Chinese patients with osteoarthritis
or rheumatoid arthritis.
Author(s): Cheung R, Cheng TT, Dong Y, Lin HY, Lai K, Lau CS, Feng H, Parsons B.
Affiliation(s): Pfizer Inc, New York, NY 10017, USA. raymond.y.cheung@pfizer.com
Publication date & source: 2010, Int J Rheum Dis. , 13(2):151-7
AIM: To test whether treatment with celecoxib reduces the incidence of
gastroduodenal ulcers compared to diclofenac in Asian patients with
osteoarthritis (OA) or rheumatoid arthritis (RA) with minimal significant risk
factors.
METHODS: Patients with a clinical diagnosis of OA or RA of at least 3 months were
randomized to 12 weeks of double-blind treatment with celecoxib 100 mg twice
daily (n = 440) or diclofenac 50 mg twice daily (n = 440). The primary outcome
was the gastric and/or duodenal ulcer rate at endpoint as determined by upper
gastrointestinal endoscopy performed during the screening week, and at endpoint.
RESULTS: There was no significant difference in the overall incidence of
gastroduodenal ulcers at 12-week endpoint for celecoxib compared to diclofenac
(2.8% vs. 5.1%; Cochran-Mantel-Haenszel [CMH] chi(2) P = 0.083). However, there
was a significantly lower incidence of gastric ulcers on celecoxib versus
diclofenac (0.5% vs. 3.6%; CMH chi(2) P = 0.002). Approximately 59% of patients
in both treatment groups had no visible gastric lesions at endpoint; and a
similar proportion were found to have one or more erosions on celecoxib (n = 85;
21.4%) and diclofenac (N = 91; 23.3%). A survival analysis of time to ulcer was
significant for gastric ulcers (log-rank P = 0.004), but not for duodenal ulcers,
or for gastroduodenal ulcers combined. Fewer patients reported at least one
adverse event on celecoxib compared to diclofenac (42.4% vs. 50.3%; chi(2), 5.52;
P = 0.019).
CONCLUSIONS: In Asian patients with minimal significant risk factors, treatment
with celecoxib was associated with a modest but significantly reduced incidence
of gastric ulcers at the end of 12 weeks.
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