Tolerance to coxibs in patients with intolerance to non-steroidal anti-inflammatory drugs (NSAIDs): a systematic structured review of the literature.

Adverse events triggered by non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common drug-related intolerance reactions in medicine; they are possibly related to inhibition of cyclooxygenase-1. Coxibs, preferentially inhibiting cyclooxygenase-2, may therefore represent safe alternatives in patients with NSAID intolerance. We reviewed the literature in a systematic and structured manner to identify and evaluate studies on the tolerance of coxibs in patients with NSAID intolerance. We searched MEDLINE (1966-2006), the COCHRANE LIBRARY (4th Issue 2006) and EMBASE (1966-2006) up to December 9, 2006, and analysed all publications included using a predefined evaluation sheet. Symptoms and severity of adverse events to coxibs were analysed based on all articles comprising such information. Subsequently, the probability for adverse events triggered by coxibs was determined on analyses of double-blind prospective trials only. Among 3,304 patients with NSAID intolerance, 119 adverse events occurred under coxib medication. All adverse events, except two, have been allergic/urticarial in nature; none was lethal, but two were graded as life-threatening (grade 4). The two non-allergic adverse events were described as a grade 1 upper respiratory tract haemorrhage, and a grade 1 gastrointestinal symptom, respectively. In 13 double-blind prospective studies comprising a total of 591 patients with NSAID intolerance, only 13 adverse reactions to coxib provocations were observed. The triggering coxibs were rofecoxib (2/286), celecoxib (6/208), etoricoxib (4/56), and valdecoxib (1/41). This review documents the good tolerability of coxibs in patients with NSAID intolerance, for whom access to this class of drugs for short-term treatment of pain and inflammation is advantageous.

Change in knowledge and skills of Year 3 undergraduates in evidence-based medicine seminars.

PURPOSE: To evaluate the effect of a compulsory evidence-based medicine (EBM) seminar in critical appraisal skills and the overall acceptance of compulsory EBM seminars for Year 3 medical undergraduate students. METHODS: Small group seminars by peer teaching were conducted for up to 23 undergraduates. Knowledge and skills in EBM before and after the compulsory seminars were evaluated by 2 different sets of 20 questions. To apply knowledge, each undergraduate had to analyse an individual paper case using the principles of EBM. Undergraduates gave anonymous feedback using separate evaluation sheets at the end of the seminar. Main outcome variables were changes in knowledge and skills. RESULTS: A total of 132 Year 3 undergraduates at the University of Frankfurt participated in a compulsory EBM seminar during the academic half-year 2003/04 as part of their regular curriculum. Complete datasets were available for evaluation from 124 undergraduates (94%). The seminars led to an overall increase in knowledge (question paper score increase from 2.37 to 7.48, 99% CI 6.61-8.36, or 216%). Transfer of knowledge into a paper case scenario was generally good, with a mean score of 49.5 (SD 5.24) out of 55 points. Feedback indicated good overall acceptance of the seminars, with a median of 2 (score range from 1 = excellent to 6 = failed). CONCLUSION: Trained medical students are effective and well accepted EBM trainers in compulsory undergraduate seminars.