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To the Editor: The results of the Celecoxib Long-term Arthritis Safety Study (CLASS)¹ support the hypothesis that celecoxib alone does not induce anatomical lesions in the gastrointestinal (GI) tract.

However, in the subgroup of patients who were receiving aspirin for cardiovascular disease there was no difference in nonsteroidal anti-inflammatory drug (NSAID)–induced GI complications between celecoxib and aspirin vs conventional ibuprofen or diclofenac and aspirin. Because cyclooxygenase (COX)-1 is responsible for GI integrity under physiological conditions and because COX-2–specific inhibitors alone do not cause anatomical lesions, we would have expected a lower rate of ulcer complications in the group receiving celecoxib and aspirin. As outlined in the accompanying Editorial by Drs Lichtenstein and Wolfe,² a possible explanation for this surprising finding might be a type II error due to the small sample size. However, the small numerical difference observed between the 2 groups suggests that even a statistically significant result in . . . [Full Text of this Article]

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