It is wise to prescribe NSAIDs with modern gastroprotective agents?

Finding scientific communities in citation graphs: Articles and authors

Understanding the nature and organization of scientific communities is of broad interest. The “Invisible College” is a historical metaphor for one such type of community that refers to a small group of scientists working on a problem of common interest. The scientific and social behavior of such colleges has been the subject of case studies that have examined limited samples of the scientific enterprise. We introduce a metamethod for large-scale discovery that consists of a pipeline to select themed article clusters, whose authors can then be analyzed. A sample of article clusters produced by this pipeline was reviewed by experts, who inferred significant thematic relatedness within clusters, suggesting that authors linked to such clusters may represent valid communities of practice. We explore properties of the author communities identified by our pipeline, and the publication and citation practices of both typical and highly influential authors. Our study reveals that popular domain-independent criteria for graphical cluster quality must be carefully interpreted in the context of searching for author communities, and also suggests a role for contextual criteria.

A framework for evaluating the clinical consequences of initial therapy with NSAIDs, NSAIDs plus gastroprotective agents, or celecoxib in the treatment of arthritis

OBJECTIVE

The purpose of this study is to provide a framework for estimating the economic efficiency of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), concomitant gastroprotective agents (GPAs) to reduce the risk of NSAID toxicity, and celecoxib, a specific cyclo-oxygenase-2 inhibitor. Concomitant GPA therapies considered include one of the following: proton pump inhibitors (PPIs) plus NSAIDs, histamine H2 receptor antagonists (H2RAs) plus NSAIDs, misoprostol plus NSAIDs, and a single tablet formulation of diclofenac/misoprostol.

DESIGN

The study employs a decision-tree framework to establish probabilities of upper gastrointestinal (GI) adverse events occurring over a 6-month time frame. Celecoxib clinical trial data are used to establish probabilities of upper GI events for celecoxib and NSAIDs, and published literature is used to predict upper GI events for the other concomitant therapies. Upper GI adverse events included in the decision-tree are as follows: GI discomfort, symptomatic ulcer, serious GI complications (with and without death), and anaemia with occult bleeding.

MAIN OUTCOME MEASURES AND RESULTS

Clinical probabilities indicate celecoxib has significant tolerability and safety advantages compared with nonselective NSAIDs. Celecoxib also reduces the risk of GI adverse events to a similar or superior degree when compared with reductions observed with NSAIDs with concomitant GPAs.

CONCLUSION

Use of celecoxib is expected to significantly reduce the economic costs of GI toxicity and its associated morbidity.