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High dosages of any NSAID increase the risk of dyspepsia

The risk of dyspepsia is increased about three-fold by high dosages of any non-steroidal anti-inflammatory drug (NSAID) and any dosage of indomethacin, meclofenamate or piroxicam, according to a meta-analysis of NSAIDs trials. The use of lower doses of NSAIDs other than indomethacin, meclofenamate or piroxicam, did not carry an elevated risk of dyspepsia.

Using published and unpublished data sources, the authors determined estimates of the risks of dyspepsia associated with NSAIDs. Data was gathered from primary studies of NSAIDs reporting on gastro-intestinal complications, as well as new drug application reviews from the FDA for the five most common NSAIDs. Meta-regression analysis assessed the impact of study and treatment level variables on the risk of dyspepsia. In total, about 5000 studies were analysed.

The authors believe that future research should focus on the development of standardized and validated measures of dyspepsia. In addition, those patient characteristics that are associated with an increased risk of NSAID-associated dyspepsia should be determined.

Ofman JJ, MacClean CH, Straus WL, et al. Meta-analysis of dyspepsia and nonsteroidal antiinflammatory drugs. Arthritis Rheum 2003;49:508-18.

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