High doses of ibuprofen increase vascular events
High-dose regimens of ibuprofen and diclofenac are associated with a moderate increase in the risk of vascular events, a meta-analysis published
in the BMJ last week suggests (2006;332:1302).
Researchers examined 138 trials, involving 145,373 participants. The
summary rate ratio for vascular events, compared with placebo, was 1.51
for high-dose ibuprofen (800mg three times daily; 95 per cent confidence
interval 0.96–2.37), 1.63 for high-dose diclofenac (75mg twice
daily; CI 1.12–2.37) and 0.92 for high-dose naproxen (500mg twice
daily; CI 0.67–1.26).
The researchers comment that they had insufficient information to determine
whether naproxen was protective or whether lower daily doses of these
drugs would have the same cardiovascular effects as these high doses.
Use of selective cyclo-oxygenase-2 inhibitors was also found to be associated
with a relative increase in the incidence of serious vascular events
compared with placebo (1.2 per cent/year compared with 0.9 per cent/year;
P=0.003). With full compliance, this might reflect an additional four
or five patients per year having a vascular event for every thousand
treated, the authors say.
However, the relatively small number of events available for analysis
limited the conclusions the researchers were able to draw, they say. “Moreover,
we limited attention to cardiovascular hazards, whereas the choice between
different anti-inflammatory regimens also needs to take account of differences
in their gastrointestinal effects,” they add. |
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