Effectiveness of Non-Steroidal Anti Inflammatory Drugs - Research Proposal Example

A systematic review on the effectiveness of NSAIDs (non-steroidal anti inflammatory drugs) on pain relief for patients suffering with stomach cancerIntroduction This is an analysis of the systematic review done by several journals regarding the effectivity of the NSAID or non-steroidal anti-inflammatory drugs in patient with stomach cancer. The systematic reviews done prove and shows that NSAID is effective in pain or even help cure cancer patients. The results of the systematic review of the journals are being presented in the table. The authors who make the study was able to show the methods they used in analyzing the NSAID. Non steroidal anti-inflammatory drugs are medications which, as well as having pain-relieving (analgesic) effects, have the effect of reducing inflammation when used over a period of time. The best known NSAID, is the original and oldest, aspirin, in use since the last century before the Food and Drug Administration (FDA) was formed. For this reason aspirin has always been an over-the-counter drug. The other NSAIDs are prescription drugs except ibuprofen (Advil, Nuprin, and others), ketoprofen (Orudis KT, Actron), and naproxen (Aleve). Other NSAIDs must be approved by the FDA for use in people with arthritis. Acetaminophen (Tylenol and others) is considered a painkiller only and is also sold over the counter. The NSAID group includes aspirin, ibuprofen (marketed under the names Motrin and Advil) and naproxen (Aleve). It does not include acetaminophen (Tylenol), which is effective against pain and fever but not against inflammation — which is a major factor in certain types of pain, such as the ache of rheumatoid arthritis. The search for the journals was done using the most trusted websites such as the yahoo and google. Upon entering the website I was able to access the MEDLINE and Cochrane website. Several studies were presented during my research, but the focus of the study is to evaluate the systematic review done by journals. Here I found a relevant study for the effectiveness of the NSAID in gastric ulcer or stomach cancer. The systematic review of the relationship of the NSAID with gastric cancer can be found in MEDLINE. A strategy of research was done to show the risk rate of the NSAID. Using the following database, Cochrane, EMBASE and MEDLINE, the systematic review shows that the use of NSAID in pain with gastric cancer can be helpful in a dose dependent manner. Continuing the search on these databases I was able to prove that the study done by Wang on the effect of NSAID in gastric ulcer can be proven. Continuing my research for the effectiveness of NSAID, I was able to open the website showing the systematic review using the database of MEDLINE, Pubmed, and Cancerlit. The said study can be found in the Oxford journals. To easily compare the result of the two reviews, the results, sources and analysis were put into a table. The conclusion of the study was based on the review done by the authors using the journal’s databases. Keywords: NSAIDs, systematic review, effectiveness and gastric cancer Systematic Review of Journals This systematic review was being studied by Wei Hong Wang, Jia Qing Huang, Ge Fan Zheng, Shiu Kum Lam, Johan Karlberg, Benjamin Chun-Yu Wong. Background: The authors of this review was able to identify the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, and the risk of gastric cancer. They performed a systematic review and meta-analysis of published studies to evaluate the association between use of this class of drugs and the risk of gastric cancer. The results and methods are being showed in the table below. The conclusion of this study shows that NSAID use was associated with a decreased risk of gastric cancer in a dose-dependent manner. This finding warrants proper clinical trials in populations with high risk of gastric cancer. The author developed the search strategy in MEDLINE and modified it for other databases. The search was limited to English-language reports of human studies. Wang and his cofounders searched the following databases: MEDLINE (1966 to December [week 4] 2006), EMBASE (1980 to the 14th week of 2005 publication years 2003 to 2005), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library Issue 4, 2004. This literature search yielded 1790 potentially relevant bibliographic records that addressed the use of ASA, COX-2 inhibitors, and other non-ASA NSAIDs . For non-ASA NSAIDS, Wang and company retrieved 364 articles for relevance assessment, and 29 studies met final inclusion criteria. One study of rofecoxib and 2 studies of celecoxib were published after completion of the task force report and are included in this report. Three cohort studies assessed the effect of non-ASA NSAIDs on CRC incidence. The Nurses Health Study was a large, good-quality, 20-year prospective follow-up of average-risk U.S. women. It showed a statistically significant dose-dependent protective effect of non-ASA NSAIDs on CRC. The magnitude of the relative risk reduction was up to 30% in colon cancer, whereas no benefit was observed for rectal cancer alone. When specific dose subgroups were analyzed, patients receiving less than 6 tablets per week or those receiving non-ASA NSAIDs irregularly did not seem to show a reduction in CRC incidence. Two other large administrative database studies of fair quality showed a statistically significant protective effect of regular non-ASA NSAIDs on the incidence of CRC. Another systematic review was done by Alaa Rostom MD. MSC, Catherine Dube, MD. MSc., Gabriela Lewin, MD, Alexander Tsertsvadze MD, MSc, Nicholas Barrowman, PhD, Catherine Code, MD, Margaret Sampson, MLIS and David MOher PhD, for US Preventive Services Task Force. The purpose of this study is to examine the benefits and harms of nonaspirin (non-ASA) nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX-2) inhibitors for the prevention of colorectal cancer (CRC) and adenoma. The conclusion of the study shows that Cyclooxygenase-2 inhibitors and NSAIDs reduce the incidence of colonic adenomas. Nonsteroidal anti-inflammatory drugs also reduce the incidence of CRC. However, these agents are associated with important cardiovascular events and gastrointestinal harms. The balance of benefits to risk does not favour chemoprevention in average-risk individuals. Methods and results of this study is showed in the table. In this study Rostom , et.al developed a search strategy in MEDLINE (2003 to the third week of December 2006) to detect recent systematic reviews that appeared to address the harms of non-ASA NSAIDs and COX-2 inhibitors. They implemented a weekly monitoring strategy to detect emerging information on cardiovascular harms associated with COX-2 inhibitors. They also monitored the U.S. Food and Drug Administration News Digest and Health Canadas Health Product Information mailing list for announcements related to COX-2 inhibitors and cardiovascular harms (monitoring dates, 14 January 2005 to 26 May 2005). Beyond these dates, they surveyed several sources to ascertain additional potentially eligible studies. Several members of the team extracted data independently by using a Web-based system (SRS 4.0, TrialStat Corp., Ottawa, Ontario, Canada). They extracted data by using the PICOS (participant, intervention and exposure, comparator, outcome, and study design) approach. The team used predefined criteria from the USPSTF to assess the quality of included systematic reviews, clinical trials, and observational studies, which they rated as good, fair, or poor. This scale relies on 4, 6, 7, and 7 criteria for systematic reviews, case–control studies, cohort studies, and RCTs, respectively. A good rating was given when all criteria were met; a fair rating when at least 80% were met and the study had no fatal flaws; and a poor rating when less than 80% of the criteria were met, when there was a fatal flaw, or both. Table 1 Methods and Results Authors / researchers Methods / Sources Results / Analysis Wei Hong Wang, et. al. Recursive literature search to January 2003 was conducted in MEDLINE, Pubmed, and CANCERLIT to identify relevant case-control or cohort studies. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under a random-effects model 9 studies ( 8 case control and one cohort),2831 case patient were identified Summary ORs 0.78 (95% CI = 0.69 to 0.87) Users of Aspirin (OR = 0.73, 95% CI = 0.63 to 0.86) experienced risk reduction. Non Aspirin NSAID (OR = 0.74, 95% CI = 0.55 to 1.00) experienced risk reduction. Regular users of NSAIDs (OR = 0.57, 95% CI = 0.44 to 0.74) experienced a lower risk of gastric cancer relative to nonusers than did irregular users (OR = 0.76, 95% CI = 0.62 to 0.94; P = .09 versus regular users). A stratified analysis showed that NSAID use was associated with a statistically significant reduction in risk of noncardia gastric cancer (OR = 0.72, 95% CI = 0.58 to 0.89), but not of gastric cancer at the cardia (OR = 0.80, 95% CI = 0.53 to 1.20). Alaa Rostom, et.al. MEDLINE (1966 to 2006), EMBASE (1980 to 2006), Cochrane Central Register of Controlled Trials, Cochrane Collaborations registry of clinical trials, Cochrane Database of Systematic Reviews. Randomized, controlled trials and case–control and cohort studies of the effectiveness of NSAIDs for the prevention of CRC and colorectal adenoma were identified by multilevel screening by 2 independent reviewers. single cohort study showed no effect of non-ASA NSAIDs on death due to CRC non-ASA NSAIDs in cohort studies (relative risk, 0.61 [95% CI, 0.48 to 0.77]) and case–control studies (relative risk, 0.70 [CI, 0.63 to 0.78]). Colorectal adenoma incidence was also reduced with non-ASA NSAID use in cohort studies (relative risk, 0.64 [CI, 0.48 to 0.85]) and case–control studies (relative risk, 0.54 [CI, 0.4 to 0.74]) and by COX-2 inhibitors in randomized, controlled trials (relative risk, 0.72 [CI, 0.68 to 0.77] Cyclooxygenase-2 inhibitors and nonnaproxen NSAIDs increase the risk for serious cardiovascular events (relative risk, 1.86 [CI, 1.33 to 2.59] for COX-2 inhibitors vs. placebo). Discussion A number of studies have shown that use of NSAIDs is associated with reduction in the incidence of a variety of gastrointestinal malignancies. The association between NSAID use and development of colorectal cancer has been studied the most); esophageal cancer), gastric cancer), liver cancer), and pancreatic cancer have been studied less extensively. A recent meta-analysis of nine observational studies suggested that long-term use of NSAIDs, including aspirin, is associated with a reduced risk of esophageal cancer. However, the association between NSAID use and gastric cancer has remained unclear. The results of the meta-analysis in this article suggest that long-term use of aspirin or non-aspirin NSAIDs is associated with a statistically significant, dose-dependent reduction in the risk of gastric cancer. When the analysis was stratified by the site of gastric cancer, use of NSAIDs was associated with a statistically significantly lower risk for noncardia gastric cancer but not gastric cancer at the cardia. The above study showed that NSAID has helped in lowering the risk of a patient with stomach cancer. In the study done by Wang et.al, they were able to show the risks (i.e., gastrointestinal complications) of regular use of conventional NSAIDs that may outweigh the potential benefits in preventing gastric cancer in populations at low risk for gastric cancer, a randomized trial of NSAIDs, including aspirin, might be appropriate in populations at high risk for gastric cancer and with high rates of H. pylori infection, especially in Japan and certain areas of China. Because COX-2-selective inhibitors (e.g., rofecoxib, celecoxib, etoricoxib) have lower gastrointestinal toxicity than nonselective NSAIDs, they may be a better option for chemoprevention in both high- and low-risk populations. Nevertheless, the question of whether the epidemiologic evidence provides a firm basis for randomized clinical trials needs to be examined carefully, especially when the evidence comes from populations with different socioeconomic and environmental backgrounds, and given that gastric carcinogenesis is a multifactorial and multistep process. The results of the systematic review of Rostom, et.al. suggest that the use of non-ASA NSAIDs for CRC chemoprevention is effective at reducing the incidence of colorectal adenomas and CRC. Cyclooxygenase-2 inhibitors seem to be effective at reducing the incidence of colorectal adenoma in patients with previous adenomatous polyps. Higher doses and longer durations of use of non-ASA NSAIDs seem to be associated with greater protection from CRC and adenomas. We found the magnitude of the relative risk reduction for CRC incidence to be approximately 30% to 40% in the pooled analyses. The systematic review of the above journals has shown that the use of NSAID in patient with stomach cancer will reduce the risk. Several journals such as MEDLINE, PUBMED, Cochrane and others are continuously upgrading their system to be able to come up with a better study regarding the effectivity of NSAID in pain. The above results of the study suggest the use of Non – ASA NSAID medicines as a cure for pain in patient with stomach cancer. Reference: 1. Alaa Rostom, MD, MSc; Catherine Dubé, MD, MSc; Gabriela Lewin, MD; Alexander Tsertsvadze, MD, MSc; Nicholas Barrowman, PhD; Catherine Code, MD; Margaret Sampson, MLIS; and David Moher, PhD, for the U.S. Preventive Services Task Force Nonsteroidal Anti-inflammatory Drugs and Cyclooxygenase-2 Inhibitors for Primary Prevention of Colorectal Cancer: A Systematic Review Prepared for the U.S. Preventive Services Task Force 6 March 2007 | Volume 146 Issue 5 | Pages 376-389 2. Rostom A, Dubé C, Lewin G, Tsertsvadze A, Barrowman N, Code C, et al. Use of aspirin and NSAIDs to prevent colorectal cancer. Evidence synthesis prepared by the University of Ottawa Evidence-based Practice Center under contract no. 290-02-0021. Rockville, MD: Agency for Healthcare Research and Quality; 2006. 3. Wei Hong Wang, Jia Qing Huang, Ge Fan Zheng, Shiu Kum Lam, Johan Karlberg, Benjamin Chun-Yu Wong Non-steroidal Anti-inflammatory Drug Use and the Risk of Gastric Cancer: A Systematic Review and Meta-analysis JNCI Journal of the National Cancer Institute Volume 95, Number 23 Pp. 1784-1791 JNCI Journal of the National Cancer Institute 2003 95(23):1784-1791; doi:10.1093/jnci/djg106 4. Maruyama M. Treatment results of gastric cancer staged by the TNM classification. In: Maruyama M, Kimura K, editors. Review of clinical research in gastroenterology. Tokyo (Japan): Igaku-Shoin; 1998. p. 112. Read More