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Association between nonnaproxen NSAIDs, COX-2 inhibitors and hospitalization for acute myocardial infarction among the elderly: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature166723
Source
Pharmacoepidemiol Drug Saf. 2007 May;16(5):493-503
Publication Type
Article
Date
May-2007
Author
Elham Rahme
Douglas J Watson
Sheldon X Kong
Youssef Toubouti
Jacques LeLorier
Author Affiliation
Department of Medicine McGill University, and Research Institute, McGill University Health Center, Montreal, Canada. elham.rahme@mcgill.ca
Source
Pharmacoepidemiol Drug Saf. 2007 May;16(5):493-503
Date
May-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Cohort Studies
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Diclofenac - adverse effects - therapeutic use
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Ibuprofen - adverse effects - therapeutic use
Lactones - adverse effects - therapeutic use
Male
Myocardial Infarction - chemically induced - epidemiology
Product Surveillance, Postmarketing - methods - statistics & numerical data
Proportional Hazards Models
Pyrazoles - adverse effects - therapeutic use
Quebec - epidemiology
Retrospective Studies
Sex Factors
Sulfonamides - adverse effects - therapeutic use
Sulfones - adverse effects - therapeutic use
Abstract
To evaluate the association between rofecoxib, celecoxib, diclofenac, and ibuprofen and the risk of hospitalization for acute myocardial infarction (AMI) in an elderly population.
We conducted a retrospective cohort study, using data from the government of Quebec health insurance agency databases, among patients 65-80 years of age who filled a prescription for any of the study drugs during 1999-2002. Cox regression models with time-dependent exposure were used to compare the incidence rates of hospitalization for AMI adjusting for patients' baseline characteristics. Analyses stratified by dose and number of supplied days were also conducted.
At the index date, a total of 91 062 patients were taking rofecoxib, 127 928 celecoxib, 49 193 diclofenac, and 15 601 ibuprofen. The adjusted hazard ratio (HR) (95%CI) of hospitalization for AMI were: celecoxib versus rofecoxib: 0.90 (0.79, 1.01); ibuprofen versus rofecoxib: 0.95 (0.65, 1.37); diclofenac versus rofecoxib: 1.01 (0.84, 1.22). In secondary analyses based on intended duration of use, neither COX-2 selective inhibitor was associated with a higher risk than ibuprofen or diclofenac. The unadjusted risk of AMI for all NSAIDs increased with dose. In the direct two way adjusted comparison of each NSAID stratified by dose, the only statistically significant difference was with rofecoxib >25 mg/day versus celecoxib >200 mg/day.
In this study there was no difference between AMI occurrence in elderly patients taking rofecoxib or celecoxib at recommended doses for chronic indications versus those taking ibuprofen/diclofenac. However, the risk of AMI was higher among patients using higher doses of rofecoxib (>25 mg/day) compared to patients using higher doses of celecoxib (>200 mg/day).
PubMed ID
17086567 View in PubMed
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[Coxibs in treatment and prevention of cancer].

https://arctichealth.org/en/permalink/ahliterature174064
Source
Duodecim. 2005;121(9):929-31
Publication Type
Article
Date
2005
Author
Mira Heinonen
Ari Ristimäki
Author Affiliation
Kliinisteoreettinen laitos, Haartman-instituutti ja HUSLAB, Molekyyl- ja syöpäbiologian tutkimusohjelma, Helsingin yliopisto.
Source
Duodecim. 2005;121(9):929-31
Date
2005
Language
Finnish
Publication Type
Article
Keywords
Cardiovascular Diseases - chemically induced - epidemiology
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Female
Finland
Follow-Up Studies
Humans
Male
Neoplasms - drug therapy - prevention & control
Risk assessment
Treatment Outcome
PubMed ID
15991735 View in PubMed
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Effect of an academic detailing intervention on the utilization rate of cyclooxygenase-2 inhibitors in the elderly.

https://arctichealth.org/en/permalink/ahliterature157581
Source
Ann Pharmacother. 2008 Jun;42(6):749-56
Publication Type
Article
Date
Jun-2008
Author
Stephen D Graham
Abraham G Hartzema
Ingrid S Sketris
Almut G Winterstein
Author Affiliation
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Source
Ann Pharmacother. 2008 Jun;42(6):749-56
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Ulcer Agents - therapeutic use
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Drug Utilization - statistics & numerical data
Education, Medical, Continuing
Evidence-Based Medicine
Female
Follow-Up Studies
Humans
Male
Middle Aged
Nova Scotia
Office visits - statistics & numerical data
Osteoarthritis - drug therapy
Physician's Practice Patterns - standards - statistics & numerical data
Physicians, Family - education
Retrospective Studies
Abstract
Osteoarthritis is prevalent in the elderly. Nova Scotia general practitioners (GPs) identified the need for an academic detailing (AD) intervention aimed at optimizing the management of osteoarthritis. AD was provided by Dalhousie University Continuing Medical Education in a face-to-face encounter employing evidence-based information. GP participation was voluntary.
To evaluate the effect of a GP-targeted osteoarthritis AD intervention on a reduction in the prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as examine the intervention effect on the utilization rates of gastroprotective agents and medical services.
A retrospective cohort study design employing administrative data was used. Differences in utilization rates between intervention and control groups were evaluated using generalized estimating equations analysis for longitudinal data over four 90-day postintervention periods. Confounding was addressed using propensity scores to adjust for between-group bias on the measured covariates.
The between-group difference for change in COX-2 utilization rates was 0.76 defined daily doses/patient (p = 0.040; 95% CI 0.037 to 1.48) for the 3-month period following the intervention, with lower COX-2 utilization in the AD intervention group than in the control group. The intervention group showed a significant decrease in the within-group utilization rate between the pre- and postintervention periods (z =-2.34; p = 0.019). The between-group difference for change in GP office visit rates was 0.40 visits/patient (p = 0.028; 95% CI 0.046 to 0.79) with the intervention group, showing higher visit rates compared with the control group.
The osteoarthritis AD intervention was associated with a significant decrease (23%) in COX-2 utilization rates in the 3-month period immediately following the intervention. The only secondary outcome to show a significant between-group effect was the GP office visit rate, which was higher for the intervention group in the second 3-month postintervention period.
PubMed ID
18430793 View in PubMed
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Gastrointestinal safety of cyclooxygenase-2 inhibitors: a Cochrane Collaboration systematic review.

https://arctichealth.org/en/permalink/ahliterature163121
Source
Clin Gastroenterol Hepatol. 2007 Jul;5(7):818-28, 828.e1-5; quiz 768
Publication Type
Article
Date
Jul-2007
Author
Alaa Rostom
Katherine Muir
Catherine Dubé
Emilie Jolicoeur
Michel Boucher
Janet Joyce
Peter Tugwell
George W Wells
Author Affiliation
Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada. arostom@ucalgary.ca
Source
Clin Gastroenterol Hepatol. 2007 Jul;5(7):818-28, 828.e1-5; quiz 768
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Arthritis - drug therapy
Canada - epidemiology
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Gastrointestinal Diseases - chemically induced - epidemiology
Gastrointestinal Tract - drug effects
Humans
Incidence
Randomized Controlled Trials as Topic
Abstract
Nonselective non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors (COX-2s) are used to treat a variety of arthritic and inflammatory conditions. The aim of this study was to assess the upper gastrointestinal (GI) harms of the long-term use of COX-2s, compared with nonselective NSAIDs and placebo, in arthritis sufferers.
A systematic review of randomized controlled trials (RCTs) was conducted. Searches were conducted in (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) the Cochrane Collaboration Library (2005), (3) MEDLINE (to December 2006), and (4) Excerpta Medica Database (EMBASE) (to June 2005). Reference lists from trials and abstracts of conference proceedings were searched by hand, and experts were contacted to identify further relevant trials. RCTs of celecoxib, rofecoxib, etoricoxib, valdecoxib, and lumiracoxib were included if they reported on endoscopic ulcers, clinically important ulcer complications, or adverse gastrointestinal (GI) symptoms with the use of these COX-2s, compared with placebo or with nonselective NSAIDs. Study selection and data extraction were performed in duplicate by independent reviewers. Data were analyzed by using Review Manager 4.2 in accordance with accepted meta-analysis techniques.
Compared with nonselective NSAIDs, COX-2s produced significantly fewer gastroduodenal ulcers (relative risk, 0.26; 95% confidence interval, 0.23-0.30) and clinically important ulcer complications (relative risk, 0.39; 95% confidence interval, 0.31-0.50), as well as fewer treatment withdrawals caused by GI symptoms. The co-administration of acetylsalicylic acid appears to reduce the GI safety of COX-2s in subgroup analyses.
COX-2s appear to offer greater upper GI safety and are better tolerated than nonselective NSAIDs. The co-administration of acetylsalicylic acid might reduce the safety advantage of COX-2s over that of nonselective NSAIDs.
PubMed ID
17556027 View in PubMed
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Nonsteroidal antiinflammatory drug use and cardiovascular risks after coronary stent implantation.

https://arctichealth.org/en/permalink/ahliterature131226
Source
Pharmacotherapy. 2011 May;31(5):458-68
Publication Type
Article
Date
May-2011
Author
Morten Schmidt
Lars Pedersen
Michael Maeng
Jens F Lassen
Timothy L Lash
Torsten T Nielsen
Henrik T Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. morten.schmidt@dce.au.dk
Source
Pharmacotherapy. 2011 May;31(5):458-68
Date
May-2011
Language
English
Publication Type
Article
Keywords
Aged
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Cardiovascular Diseases - etiology - mortality - prevention & control - therapy
Cohort Studies
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Databases, Factual
Denmark - epidemiology
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors - adverse effects - therapeutic use
Proportional Hazards Models
Registries
Retrospective Studies
Risk
Severity of Illness Index
Stents - adverse effects
Abstract
To determine whether use of nonselective nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2)-selective inhibitors in patients with coronary stents increased the 3-year rate of major adverse cardiovascular events (MACE).
Population-based cohort study.
The Danish National Patient Registry, the Western Denmark Heart Registry, the Danish Nationwide Prescription Database, the Danish Civil Registration System, and the National Registry of Causes of Deaths.
A total of 13,001 patients who underwent first-ever percutaneous coronary intervention with stent implantation between January 1, 2002, and June 30, 2005.
All patients were followed for 3 years after stent implantation for MACE, defined as the first occurrence of myocardial infarction, stent thrombosis, target-lesion revascularization, or cardiac death. Patients' comorbidities were identified from the hospital registries; time-varying use of NSAIDs and concomitant drugs was determined from the Danish Nationwide Prescription Database. For each clinical outcome (MACE), the 3-year risk was computed. We used Cox proportional-hazards regression analysis to compute hazard ratios (HRs) as a measure of relative risk, controlling for potential confounders. During the follow-up period, 5407 patients (41.6%) redeemed at least one NSAID prescription. There were 686 hospitalizations for myocardial infarction (5.3% of patients), 146 for stent thrombosis (1.1%), and 1091 for target-lesion revascularization (8.4%). A total of 1220 patients (9.4%) died during the follow-up period; 637 (4.9%) died of cardiac causes. Compared with no NSAID use, the adjusted HR for MACE was 1.04 (95% confidence interval [CI] 0.83-1.31) for nonselective NSAID use and 1.00 (95% CI 0.81-1.25) for COX-2 inhibitor use.
Use of nonselective NSAIDs or COX-2 inhibitors was not associated with an increased rate of MACE in patients with coronary stents. However, we cannot rule out small risks associated with individual NSAIDs.
PubMed ID
21923427 View in PubMed
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Prescription channeling of COX-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs: a population-based case-control study.

https://arctichealth.org/en/permalink/ahliterature175937
Source
Arthritis Res Ther. 2005;7(2):R333-42
Publication Type
Article
Date
2005
Author
Yola Moride
Thierry Ducruet
Jean-François Boivin
Nicholas Moore
Sylvie Perreault
Sean Zhao
Author Affiliation
Faculty of Pharmacy, Université de Montréal, Montreal, Canada. yola.moride@umontreal.ca
Source
Arthritis Res Ther. 2005;7(2):R333-42
Date
2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - contraindications - therapeutic use
Case-Control Studies
Confounding Factors (Epidemiology)
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Databases, Factual
Drug Prescriptions - statistics & numerical data
Drug Utilization
Female
Formularies as Topic
Gastritis - epidemiology
Gastrointestinal Hemorrhage - chemically induced - epidemiology - prevention & control
Humans
Insurance Coverage
Insurance, Pharmaceutical Services
Lactones - adverse effects - therapeutic use
Logistic Models
Male
Medicine
Middle Aged
Multivariate Analysis
Prevalence
Pyrazoles - adverse effects - therapeutic use
Quebec - epidemiology
Risk factors
Sampling Studies
Sex Factors
Specialization
Sulfonamides - adverse effects - therapeutic use
Sulfones - adverse effects - therapeutic use
Abstract
This pharmacoepidemiologic study was conducted to determine whether risk factors for upper gastrointestinal bleeding influenced the prescription of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) at the time when COX-2 inhibitors were first included in the formulary of reimbursed medications. A population-based case-control study was conducted in which the prevalence of risk factors and the medical histories of patients prescribed COX-2 inhibitors and traditional nonselective NSAIDs were compared. The study population consisted of a random sample of members of the Quebec drug plan (age 18 years or older) who received at least one dispensation of celecoxib (n = 42,422; cases), rofecoxib (n = 25,674; cases), or traditional nonselective NSAIDs (n = 12,418; controls) during the year 2000. All study data were obtained from the Quebec health care databases. Adjusting for income level, Chronic Disease Score, prior use of low-dose acetylsalicylic acid, acetaminophen, antidepressants, benzodiazepines, prescriber specialty, and time period, the following factors were significantly associated with the prescription of COX-2 inhibitors: age 75 years or older (odds ratio [OR] 4.22, 95% confidence interval [CI] 3.95-4.51), age 55-74 years (OR 3.23, 95% CI 3.06-3.40), female sex (OR 1.52, 95% CI 1.45-1.58), prior diagnosis of gastropathy (OR 1.21, 95% CI 1.08-1.36) and prior dispensation of gastroprotective agents (OR 1.57, 95% CI 1.47-1.67). Patients who received a traditional nonselective NSAID recently were more likely to switch to a coxib, especially first-time users (OR 2.17, 95% CI 1.93-2.43). Associations were significantly greater for celecoxib than rofecoxib for age, chronic NSAID use, and last NSAID use between 1 and 3 months before the index date. At the time of introduction of COX-2 inhibitors into the formulary, prescription channeling could confound risk comparisons across products.
Notes
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PubMed ID
15743481 View in PubMed
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Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature81805
Source
Circulation. 2006 Jun 27;113(25):2906-13
Publication Type
Article
Date
Jun-27-2006
Author
Gislason Gunnar H
Jacobsen Søren
Rasmussen Jeppe N
Rasmussen Søren
Buch Pernille
Friberg Jens
Schramm Tina Ken
Abildstrom Steen Z
Køber Lars
Madsen Mette
Torp-Pedersen Christian
Author Affiliation
Department of Cardiology, Gentofte University Hospital, DK-2900 Hellerup, Denmark. gg@heart.dk
Source
Circulation. 2006 Jun 27;113(25):2906-13
Date
Jun-27-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Confidence Intervals
Cross-Over Studies
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Denmark
Diclofenac - adverse effects - therapeutic use
Dose-Response Relationship, Drug
Female
Humans
Ibuprofen - adverse effects - therapeutic use
Lactones - adverse effects - therapeutic use
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy - mortality
Odds Ratio
Patient Readmission
Proportional Hazards Models
Pyrazoles - adverse effects - therapeutic use
Recurrence
Registries
Retrospective Studies
Risk factors
Sulfonamides - adverse effects - therapeutic use
Sulfones - adverse effects - therapeutic use
Abstract
BACKGROUND: The selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk, but the risk in patients with established cardiovascular disease is unknown. We analyzed the risk of rehospitalization for acute myocardial infarction (MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with prior MI. METHODS AND RESULTS: All patients with first-time MI between 1995 and 2002 as well as all prescription claims for NSAIDs after discharge were identified from nationwide Danish administrative registers. The risk of death and rehospitalization for MI associated with the use of selective COX-2 inhibitors and nonselective NSAIDs was studied with the use of multivariable proportional hazards models and case-crossover analysis. A total of 58 432 patients were discharged alive and included in the study; 9773 experienced rehospitalization for MI, and 16 573 died. A total of 5.2% of patients received rofecoxib, 4.3% celecoxib, 17.5% ibuprofen, 10.6% diclofenac, and 12.7% other NSAIDs. For any use of rofecoxib, celecoxib, ibuprofen, diclofenac, and other NSAIDs, the hazard ratios and 95% confidence intervals for death were 2.80 (2.41 to 3.25; for rofecoxib), 2.57 (2.15 to 3.08; for celecoxib), 1.50 (1.36 to 1.67; for ibuprofen), 2.40 (2.09 to 2.80; for diclofenac), and 1.29 (1.16 to 1.43; for other NSAIDS); there were dose-related increases in risk of death for all of the drugs. There were trends for increased risk of rehospitalization for MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs. CONCLUSIONS: Selective COX-2 inhibitors in all dosages and nonselective NSAIDs in high dosages increase mortality in patients with previous MI and should therefore be used with particular caution in these patients.
Notes
Comment In: Circulation. 2006 Jun 27;113(25):2868-7016785335
PubMed ID
16785336 View in PubMed
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Risk of upper gastrointestinal bleeding with oral bisphosphonates and non steroidal anti-inflammatory drugs: a case-control study.

https://arctichealth.org/en/permalink/ahliterature151960
Source
Aliment Pharmacol Ther. 2009 Jun 1;29(11):1188-92
Publication Type
Article
Date
Jun-1-2009
Author
M. Etminan
L. Lévesque
J M Fitzgerald
J M Brophy
Author Affiliation
Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. mahyar.etminan@vch.ca
Source
Aliment Pharmacol Ther. 2009 Jun 1;29(11):1188-92
Date
Jun-1-2009
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Case-Control Studies
Cyclooxygenase 2 Inhibitors - adverse effects - therapeutic use
Diphosphonates - adverse effects - therapeutic use
Drug Interactions
Drug Therapy, Combination
Female
Gastrointestinal Agents - therapeutic use
Gastrointestinal Hemorrhage - chemically induced - epidemiology
Humans
Male
Odds Ratio
Quebec - epidemiology
Risk factors
Treatment Outcome
Abstract
Gastrointestinal injuries including gastric ulcers have been reported with oral bisphosphonate therapy. However, the risk of the more serious upper gastrointestinal bleeding (UGB) especially in the community setting with these drugs remains unknown. Similarly, the risk of UGB among users of both bisphosphonates and non steroidal anti-inflammatory drugs (NSAIDs) in the community is also unknown.
To explore the risk of more serious UGB among users of bisphosphonates and the risk of UGB among users of both bisphosphonates and NSAIDs in the community.
We conducted a case-control study within a cohort of Quebec residents who had received a revascularization procedure from 1995 to 2004. Cohort members were followed up from the date of their first procedure until the earliest of: (1) study outcome, (2) date of death or (3) end of health care coverage. Cases were defined as those with the first diagnosis of a UGB. For each case, 20 controls were selected and matched to the cases by index date, age and cohort entry. Adjusted odds ratios for current use of bisphosphonates, NSAIDs and co-therapy of both drugs were computed.
Within the initial cohort, 3253 incident cases of UGBs and corresponding 65 060 matched controls were identified. The adjusted odds ratio (OR) for UGB by current users of bisphosphonates was 1.01 (95% CI, 0.72-1.43). Current NSAID use was associated with an increased risk of UGB OR = 1.75; 95% CI, 1.53-1.99. The OR for use of bisphosphonates and NSAIDs was elevated OR = 2.00; 95% CI, 1.12-3.57. This risk was still elevated for users of bisphosphonates and COX-2 inhibitors [OR = 2.38 (95% CI, 1.26-4.50)].
We found no evidence of an increase in the risk of UGB among current users of bisphosphonates. The risk of combined NSAID and bisphosphonate therapy was increased, but this risk was not higher than the risk for NSAID users alone.
PubMed ID
19298582 View in PubMed
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11 records – page 1 of 2.