Celecoxib gentler on intestinal mucosa than loxoprofen/lansoprazole combo

Last Updated: 2015-08-13

By David Douglas

NEW YORK (Reuters Health) - A study in healthy volunteers shows that celecoxib monotherapy causes less small intestinal mucosal injury than combination therapy with loxoprofen and the proton pump inhibitor (PPI) lansoprazole, according to Japanese researchers.

Moreover, Dr. Shunji Fujimori told Reuters Health by email, "The short-term use of celecoxib monotherapy is highly safe."

In a July 9 online paper in the Journal of Clinical Gastroenterology, Dr. Fujimori, of Nippon Medical School, Tokyo, and colleagues noted that loxoprofen is a prodrug nonselective nonsteroidal anti-inflammatory drug (NSAID) developed to protect the upper gastrointestinal tract from toxicity. It is often administered along with a PPI.

There is some evidence that the cyclooxygenase-2 (COX-2) selective inhibitor celecoxib may induce fewer small intestinal injuries. The researchers randomized 150 persons (aged 40 to 70, evenly split by sex) to celecoxib (200 mg daily) or loxoprofen (180 mg daily) plus lansoprazole (15 mg daily).

After 14 days all subjects underwent capsule endoscopy. The proportion of those with at least one post-treatment mucosal break was significantly lower in the celecoxib group than in the other group (10% versus 49%; p<0.0001). This was also the case for the mean number of small intestinal mucosal breaks (0.3 versus 6.8; p<0.0001).

However, the investigators wrote, the gastrointestinal protective effect of celecoxib was "not perfect," as these subjects showed a slight decrease in hemoglobin concentration, assumed to be due to minor gastrointestinal bleeding. But the reduction was significantly less than in the combination group (2.1% versus 5.1%; p=0.006).

"This study reproved that celecoxib monotherapy causes less small intestinal mucosal injury than combination therapy of traditional NSAIDs and PPIs in Japanese subjects," the researchers wrote. "Thus, it is clear that the prodrug effect of loxoprofen to protect gastrointestinal tract does not include the small intestine."

The researchers concluded, "In terms of protection of small intestine from NSAIDs toxicity, celecoxib monotherapy was superior to loxoprofen + lansoprazole combination therapy."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1Mm0MzK

J Clin Gastroenterol 2015.