Risks of clinically significant upper gastrointestinal events with etodolac and naproxen: A historical cohort analysis

Rick A. Weideman, Kevin C. Kelly, Salahuddin Kazi, Anh Cung, Kevin W. Roberts, Herbert J. Smith, George A. Sarosi, Bertis B. Little, Byron Cryer

Research output: Contribution to journalArticle

27 Scopus citations


Background & Aims: Etodolac is a generic nonsteroidal anti-inflammatory drug (NSAID). Previous in vitro studies have shown that etodolac is a selective inhibitor of cyclooxygenase (COX)-2 with selectivity in between that of other COX-2 inhibitors such as celecoxib and rofecoxib. However, there are no outcomes data assessing clinically significant upper gastrointestinal (CSUGI) events with etodolac. Methods: A historical cohort study was performed at the Dallas Veterans Affairs Medical Center in which 16,286 veteran patients (5596 patient-years) received etodolac or naproxen during a 3-year period without concurrent use of other ulcerogenic drugs other than low-dose aspirin. The primary outcome was the CSUGI event rate of the etodolac and naproxen groups without concomitant low-dose aspirin. Results: The incidence of CSUGI events was. 78% and. 24% for naproxen and etodolac, respectively. In the NSAID-naive subset, the incidence of CSUGI events was. 99% and. 24% for naproxen and etodolac, respectively. Compared with naproxen, etodolac was associated with a reduction in upper gastrointestinal events, corresponding to an odds ratio of. 39 (95% confidence interval,. 20-.76; P =. 006). Concomitantly used low-dose aspirin increased event rates with naproxen 2-fold and etodolac 9-fold. Hence, there was no significant difference in gastrointestinal event rates between etodolac and naproxen when low-dose aspirin was taken concomitantly. Conclusions: Etodolac is a generic COX-2 selective inhibitor that reduces CSUGI events compared with the nonselective NSAID naproxen. However, concomitant use of low-dose aspirin negates the gastrointestinal safety advantages of etodolac.

Original languageEnglish (US)
Pages (from-to)1322-1328
Number of pages7
Issue number5
StatePublished - Nov 2004


ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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