Meta-analysis indicates celecoxib has CV risk similar to other NSAIDs
A meta-analysis on the cardiovascular safety of the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib (Celebrex) has found no significant increase in risk against placebo or other non-steroidal anti-inflammatory drugs (NSAIDs).
Data from the analysis of 44,300 patients from 41 studies were presented
at last week’s American
College of Rheumatology meeting in San
Diego, California.
The relative risk of non-fatal myocardial infarction with 200mg or less
of celecoxib was 1.24 compared with placebo (95 per cent confidence interval
0.27–5.76). The corresponding relative risk of cardiovascular death
was 1.74 (0.49–6.17). When compared against other NSAIDs the relative
risk for non-fatal MI was 1.49 (0.82–2.70) and 0.72 (0.37–1.39)
for cardiovascular death.
The only difference that was significant was the one that showed that
non-fatal strokes were less likely with celecoxib than other NSAIDs (relative
risk 0.33, 0.14–0.78).
Lead author, Lee Simon, associate chief of medicine at Beth Israel Deaconess
Medical Centre, Boston, and former director of the US Food and Drug Administration
section division that deals with analgesics and anti-inflammatories,
said that it is now clear that there is a signal of increased CV risk
with all NSAIDs, whether selective or not. “The truth is that all
NSAIDs have inherent risk to a greater or lesser degree. Rofecoxib at
doses of 25mg or over looks like being the worst, while celecoxib at
the usual dose of 200mg looks like being one of the best,” he added.
The mechanism behind the increase in cardiovascular risk with NSAIDs
is still unclear said Dr Simon, but it could be associated with rises
in blood pressure. |
The
Pharmaceutical Journal
Acrobat
Reader