DO COX-2 INHIBITORS GIVE ENOUGH GASTROINTESTINAL PROTECTION?
The primary endpoint of the MEDAL programme was thrombotic cardiovascular events. The MEDAL programme allowed patients to take proton-pump inhibitors (PPI) or low-dose aspirin, and as a consequence, groups were not randomly allocated: about a third used low-dose aspirin and a third used a PPI. The real question is whether a COX-2 inhibitor, such as etoricoxib, is safer than a PPI added to a standard non-steroidal anti-inflammatory drug. The advantage of the PPI option is that it is less expensive, potentially less cardiotoxic, and advantageous in terms of reducing dyspepsia, but confirmation of this needs a new randomised trial. Joost PH Drenth, Freek WA Verheugt, The Lancet 2007; 369 : 439-40.
