Heart failure may be lower with celecoxib than other NSAIDs
Patients treated with the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib (Celebrex) may have a lower risk of congestive heart failure than those treated with other non-steroidal anti-inflammatory drugs, say Canadian researchers.
They examined the incidence of hospital admissions for congestive heart
failure among 38,882 elderly patients who were being treated with rofecoxib
(Vioxx), celecoxib or non-selective NSAIDs and compared this with the
incidence among 100,000 patients who had never used NSAIDs.
Compared with non-users of NSAIDs, patients treated with rofecoxib or
non-selective NSAIDs had an increased risk of hospital admission for
heart failure of 80 per cent and 40 per cent, respectively. On the other
hand,
patients treated with celecoxib had the same rate of hospital admission
for heart failure as people who had never used NSAIDs. The
researchers suggest that differences in the pharmacokinetic properties
of rofecoxib and celecoxib may explain the findings. “Rofecoxib
has a substantially longer elimination half-life than celecoxib. Further,
celecoxib has linear pharmacokinetics with no evidence of accumulation.”
However, they add that celecoxib may not be entirely devoid of clinically
important
cardiovascular effects since the study revealed an increased frequency
for treatment of
hypertension or congestive heart failure being initiated in users of
the drug (Lancet 2004;363:1751).
A spokeswoman for Merck Sharp & Dohme, manufacturer of Vioxx, said
it was important to interpret the study, which was observational, in
the context of results seen from randomised controlled trials. |
The
Pharmaceutical Journal
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