Minor
Established
Description
Combining aspirin with celecoxib provides no additional gastroprotective benefit over aspirin alone and may negate the GI advantage of celecoxib, increasing the risk of mucosal injury.
Mécanisme
Aspirin inhibits COX-1 (and to a lesser extent COX-2), causing gastric mucosal injury; celecoxib's GI safety advantage over non-selective NSAIDs is largely lost when aspirin is co-administered.
Signification clinique
The CLASS trial showed that the GI safety advantage of celecoxib over diclofenac/ibuprofen was abolished when patients were on concurrent aspirin.
Prise en charge
Add a PPI when using celecoxib + aspirin; if the primary goal is GI safety, combining celecoxib with aspirin defeats this purpose.