Lower GI bleeding

Celecoxib was launched on the market because of its upper GI safety profile benefit compared to nsNSAIDs. However, several studies showed in recent years that apart from upper GI bleeding, NSAIDs also causes lower GI bleeding and ulcers. In a 6-month randomized, open-label trial, the incidence of upper and lower GI events was compared between celecoxib and nsNSAIDs. A total... 

To study effects on clinically important GI complications with celecoxib, the CLASS study used celecoxib (400 mg twice daily, or twice the highest FDA-approved dose) compared to diclofenac and ibuprofen at standard dose. Celecoxib use was reported to be associated with a reduced incidence for the combined end point of symptomatic ulcers and ulcer complications (perforations, gastric outlet obstruction, or bleeding). Some subjects also used aspirin for car-dioprotection, but there is concern that GI safety of COX-2 inhibitors is blunted with use of concomitant aspirin (even 30 mg of aspirin can suppress gastric prostaglandin prodnction)." For patients taking aspirin and celecoxib, nicer complications were higher than with celecoxib only, but lower than with traditional NSAIDs. 

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