Researchers have published in the current issue of The Lancet the most comprehensive analyses of the benefits and risks of non-steroidal anti-inflammatory drugs (NSAIDs), which include cyclo-oxygenase-2 inhibitors (coxibs).
Under the direction of the Clinical Trial Service and Epidemiology Studies Unit at the University of Oxford, researchers from around the world conducted a world-wide meta-analyses using individual participant data from 280 trials of NSAIDs vs. placebo and 474 trials of NSAID vs. another NSAID, which involved a total of 353,809 participants and a total of 233,798 person-years. These results address risks and benefits of drugs used for relief of inflammatory arthritis including cardiovascular disease and other relevant outcomes such as gastrointestinal effects.
"The vascular risks of high-dose diclofenac and ibuprofen are comparable to coxibs, while high-dose naproxen is associated with less vascular risk than other NSAIDs," said Charles H. Hennekens, MD, DrPH, the first Sir Richard Doll professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University. "Although NSAIDs increase vascular and gastrointestinal risks, their magnitude can be predicted, which may help guide clinical decision-making."
David J. Bjorkman, MD, MSPH, dean of the Charles E. Schmidt College of Medicine at FAU and a gastroenterologist noted that "these are the most comprehensive analyses ever conducted of the benefits and risks of NSAIDs, which include coxibs, and should help guide healthcare providers in their prescribing patterns."
Hennekens concluded that "from a clinical and policy perspective, the available data suggest that for relief of pain of inflammatory arthritis, naproxen may have the best benefit-to-risk ratio on cardiovascular disease (CVD). In contrast to naproxen, other traditional NSAIDS and coxibs confer similar moderately increased risks of CVD. At present, individual clinical judgments about coxibs and nonselective NSAIDs should not be limited to risks of CVD. They should also include concerns about non-CVD risks, such as gastrointestinal bleeding and other benefits, including improved quality of life resulting from decreases in impairment from musculoskeletal pain syndromes."
- Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. The Lancet, 2013; DOI: 10.1016/S0140-6736(13)60900-9
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