Gastroenterology: ibuprofen was the safest NSAID.

Clinical bottom line (level 3a)

  1. Patients who take ibuprofen were least likely to require admission to hospital with serious gastrointestinal complications, compared with other NSAIDs.
Henry et al: British Medical Journal 1996; 312: 1563-1566
Expires October 2002

The study

Systematic review of all controlled epidemiological studies of
  • Patients: in the community
  • Intervention: NSAIDs
  • Outcome: serious peptic ulcer complications requiring admission to hospital


Articles found in ?English using MEDline, 1985 to 1994 (search terms: ) and reviewing bibliographies of previously published meta-analyses and reviews. Authors of relevant studies were also contacted.

Selection criteria: by two independent reviewers
Appraisal criteria: ascertainment and validation of study outcomes, selection and comparability of controls, ascertainment of exposure, and control or adjustment for potential confounders.
Articles excluded if:
  • no data on the use of individual drugs or showing an association with GI damage


12 studies found on 14 NSAIDs. Doses were at least: ibuprofen 1200 mg, naproxen 500 mg, indomethicin 75 mg daily.
  • Drugs were compared against ibuprofen.
No significant heterogeneity was noted.

The evidence

risk factor for
serious gastrointestinal complications 		adjusted OR
(95% CI)
ibuprofen 1.0
(- to -)
fenoprofen 1.6
(1.0 to 2.5)
aspirin 1.6
(1.3 to 2.0)
diclofenac 1.8
(1.4 to 2.3)
sulindac 2.1
(1.6 to 2.7)
diflunisal 2.2
(1.2 to 4.1)
naproxen 2.2
(1.7 to 2.9)
indomethacin 2.4
(1.9 to 3.1)
tolmetin 3.0
(1.8 to 4.9)
piroxicam 3.8
(2.7 to 5.2)
ketoprofen 4.2
(2.7 to 6.4)
azapropazone 9.2
(4.0 to 21.0)

Comments

  1. Dose of ibuprofen was low (1200mg/day) and benefits may not persist when higher doses are used.
  2. No PEER was given, so numbers-needed-to-harm could not be calculated.

Citation

  1. Henry D, Lim L, Rodriguez LA, et al: variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. British Medical Journal 1996; 312: 1563-1566
Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer: Daniel Sontheimer

Clinical Question.
    Patient in the community
    Intervention or Exposure NSAIDs
    Outcome gastrointestinal complications