Effect of sequential NSAID therapy on the upper gastrointestinal tract in dogs

Abstract

It is unknown whether overlapping or sequential use of nonsteroidal anti-inflammatory (NSAIDs) results in an increased risk for gastrointestinal (GI) ulceration. The purpose of this pilot study was to evaluate the GI effects of various combinations of an injectable NSAID followed by an oral NSAID, a scenario often employed clinically for management of the pre- and post-operative canine patient. Six healthy Walker hounds received four treatment regimens in a randomized, cross-over design with a 2 week washout period between each treatment week: carprofen (4 mg kg–1, SQ) followed by placebo (PO, q24 × 4 days); placebo (SQ) followed by deracoxib (3–4 mg kg–1, PO, q24 × 4 days); carprofen (4 mg kg–1, SQ) followed by carprofen (4 mg kg–1, PO, q24 × 4 days); carprofen (4 mg kg–1, SQ) followed by deracoxib (3–4 mg kg–1, PO, q24 ×4 days). Weekly bloodwork (CBC, biochemistry panel, fecal evaluation, fecal occult blood) and daily clinical scoring (TPR, vomiting, diarrhea, appetite) were obtained. GI endoscopy was performed on days –2, 1, 2, 5, and 11 days post treatment of each treatment period and lesions scored using a previously reported 6-point scale. Data was analyzed using a mixed anova for repeated measures. There were no significant differences in clinical or clinicopathologic data between groups. Within the carprofen-carprofen and carprofen-deracoxib groups, lesions worsened by Day 5 (1 day after last oral dose) for the fundic and antral regions (p < 0.05). Fundic, antral and lesser curvature lesions improved by Day 5 in the carprofen-placebo group and lesser curvature lesions improved in the placebo-deracoxib group (p < 0.05). No significant within-group differences were noted for the esophagus, cardia or duodenum. The small number of dogs precludes general conclusions about the safety of sequential NSAID use, but these results suggest that a larger scale study is warranted.