Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
In Reply: Drs Fernandez and Lesser are concerned
about our inclusion criteria that allowed patients to use concomitant rheumatoid
arthritis drugs (eg, glucocorticoids and methotrexate). However, these therapies
are included in the standard of care for the treatment of rheumatoid arthritis,
and we found that neither glucocorticoid use nor age significantly modified
the effects of celecoxib or naproxen on the upper GI tract mucosa. For patients
younger than 65 years, the incidence of gastroduodenal ulceration with naproxen
was 27% in glucocorticoid users vs 26% in nonusers; in patients aged 65 years
or older, the incidence was 36% in glucocorticoid users and 21% in nonusers.
These data indicate that the susceptibility for NSAID-induced upper GI tract
ulceration is not isolated to a selected subgroup of "at-risk" patients and
the clinical benefit of celecoxib appears to extend to all patients similar
to those studied.
Simon LS. Cyclooxygenase 2 Selective Agents and Upper Gastrointestinal Disease—Reply. JAMA. 2000;283(15):1961-1962. doi:10.1001/jama.283.15.1957