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Letters to the Editor
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COX-2s
Inaccurate conclusions
From Dr C. Walker
Further to your report, “COX-2
inhibitors do not offer GI benefit over other NSAIDs” (PJ, 10 December, p714), on the Hippisley-Cox
paper published in the BMJ, I wish to express concerns that the conclusions
drawn do not accurately reflect the data as presented, and repeating
these in your publication may cause confusion among patients and doctors
as they make important health care decisions.
This study found important differences between celecoxib and the studied
non-steroidal anti-inflammatory drugs in terms of the risk of gastrointestinal
adverse effects. Specifically, celecoxib was the only treatment that
did not significantly increase the risk of GI adverse events (adjusted
RR 1.11, 95 per cent CI 0.86–1.41) compared with control patients.
The authors comment that the number of celecoxib-taking patients was
low, yet the upper limit of the 95 per cent CI for celecoxib is less
than the lower limits for naproxen (1.73), diclofenac (1.78), other NSAIDs
(1.43) and aspirin (1.49) — supporting the relative GI safety of
celecoxib.
The findings are consistent with the results of other studies. NSAIDs
typically increase GI bleed risks two- to four-fold. For example, Mamdani
(BMJ 2002;325:624–7) studied 1.3 million elderly patients in the
Canadian population and found that celecoxib was not associated with
increased risk of admission to hospital for GI haemorrhage — as
opposed to the significantly increased risk seen with other NSAIDs.
We do not believe that the conclusion of the Hippisley-Cox article — as
well as the comment in the PJ on 13 December — fully acknowledges
safety differences that the data showed among various arthritis treatment
options. In this study, celecoxib was the treatment with the lowest risk
of GI complications — important information for patients and doctors
who are making health decisions. The study conclusions and the PJ report
may create an impression that is not fully supported by the data as presented.
Chris Walker
Senior Scientific Adviser COX-2s
Pfizer Ltd
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The
Pharmaceutical Journal