GI safety of ibuprofen confirmed - again

A study for the World Health Organisation has confirmed that ibuprofen is associated with the lowest risk of gastrointestinal (GI) complications among NSAIDs (Richy F et al. Ann Rheum Dis 2004;63:759-66 ).

Investigators conducted a meta-analysis of controlled trials reporting the adverse effects of NSAIDs conducted between 1985 and 2003. The 32 randomised trials and 13 cohort studies included a total of 5,325 patients taking an NSAID and 3,453 controls. In the three studies involving ibuprofen, the median dose was 1200 mg/day. GI complications were defined as any ulcer, bleeding, perforation, hospitalisation or related death.

Overall, the relative risk of GI complications with NSAID use was 1.54 (CI 95% 1.4 - 1.7) in randomised trials over 28 days, or 2.2 (CI 95% 1.7 - 2.9) in cohort studies over one year. Of seven NSAIDs assessed, the risk was greatest with indomethacin (RR 2.25, CI 95% 1.10 - 5.07) and lowest with ibuprofen (RR 1.19, CI 95% 0.93 - 1.54); relative risks were also significantly increased for naproxen (1.83), diclofenac (1.73) and piroxicam (1.66). Complications associated with indomethacin tended to occur after 7 days compared with 2 - 3 months with other NSAIDs. The authors confirm current advice that NSAIDs should be prescribed cautiously for patients who need long term management.

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