Epidemiology and pharmacoeconomic implications of non-steroidal anti-inflammatory drug-associated gastrointestinal toxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and us ed, especially to treat patients with osteoarthritis and rheumatoid arthrit is. Since their introduction as a therapeutic class, a large body of litera ture has accumulated on the side-effects of these drugs. NSAIDs, through th eir inhibition of prostaglandin synthesis, can affect the renal and cardiov ascular systems. However, the majority of reported side-effects are related to the gastrointestinal (GI) system, and the occurrence of these GI events adds significantly to the disease burden. Several factors have been identi fied that contribute to the risk of an NSAID-associated CI event. However, when considering risk, especially in clinical trials or observational studi es, it is necessary to distinguish between baseline risk and NSAID-attribut able risk, since this distinction can affect the results and conclusions of the study; NSAID-attributable risk is present in subjects who have few or no risk factors for upper GI toxicity. Safer NSAIDs, such as the new specif ic cyclooxygenase-2 inhibitors, when targeted to the appropriate patient (i .e. those with NSAID-attributable risk), should lead to improved outcomes a nd reduced costs.