The introduction of selective cyclooxygenase-2 inhibitors (COX-2 inhibitors, or coxibs), a group of nonsteroidal anti-inflammatory drugs (NSAIDs) widely used to treat arthritis and musculoskeletal problems, has resulted in a rapid increase in the number of people exposed to NSAIDs. Compared with traditional NSAIDS, coxibs are felt to offer a lower risk of stomach bleeding.
However, studies indicate that many patients who would otherwise not have used an NSAID are now using coxibs, with the net result of increased population rates of upper gastrointestinal (GI) bleeding. Mamdani and coauthors report on their comparison of changes over time in NSAID use and upper GI bleeding rates in British Columbia, which restricts the use of these drugs, and in Ontario, which has a less restrictive drug coverage policy. Their findings suggest that a more restrictive drug coverage policy, although limiting access to drugs and their potential benefits, may protect the population from adverse drug effects.
p.1535 Changes in rates of upper gastrointestinal hemorrhage after the introduction of cyclooxygenase-2 inhibitors in British Columbia and Ontario http://www.cmaj.ca/pressrelease/pg1535.pdf
Canadian Medical Association Journal