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April 19, 2000

Cyclooxygenase 2 Selective Agents and Upper Gastrointestinal Disease

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(15):1961-1962. doi:10.1001/jama.283.15.1957

To the Editor: The study by Dr Simon and colleagues1 found a markedly reduced frequency of upper GI tract toxicity in subjects receiving celecoxib vs those receiving naproxen, although the importance of that finding for predicting clinical events is still uncertain. Nonetheless, the reason for this difference is not necessarily that celecoxib is COX-1 sparing. The hypothesized protective role of COX-1 has obtained most of its support from the observations that several "COX-2–selective" NSAIDs appear to have less GI tract toxicity and that administering misoprostol also reduces the risk. But that is circumstantial evidence only, and misoprostol has other pharmacological properties that may explain its protective effect.

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