Prevention

If patients need to continue NSAIDs, consider a COX-2 inhibitor such as rofecoxib ^a or celecoxib ^{a b}

Why?

• Rofecoxib ^a and celecoxib ^{a b} are as effective as naproxen.
• Fewer patients develop gastroduodenal ulcers ^{a b} and fewer discontinue medication or have GI complications compared with NSAIDs. ^a

Rofecoxib and celecoxib causes fewer GI complications or withdrawals than NSAIDs

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
osteoarthritis a	rofecoxib	NSAIDs	discontinued medication at 4 months	37%	17% (10% to 23%)	16 (11 to 29)
			discontinuation due to adverse GI symptoms at 4 months	4.8%	27% (3% to 45%)	78 (40 to 1930)
			gastroduodenal ulcer on endoscopy at 4 months	8.1%	77% (68% to 83%)	16 (13 to 21)
			GI perforation, symptomatic gastroduodenal ulcer or upper GI bleeding at 4 months	1.5%	63% (33% to 80%)	100 (61 to 320)
osteoarthritis or rheumatoid arthritis	celecoxib	diclofenac	gastroduodenal ulcer, upper GI bleeding, perforation, gastric outflow obstruction at 6 months	1.3%	37% (3% to 60%)	210 (110 to 3200)
			withdrawal due to adverse effects at 6 months	20%	11% (3% to 19%)	44 (25 to 190)