Risk of heart failure may be lower with celecoxib than with other NSAIDs
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《英国医生杂志》
The anti-inflammatory cyclo-oxygenase-2 (COX 2) inhibitor celecoxib may be associated with a lower risk of congestive heart failure in the elderly than other non-steroidal anti-inflammatory drugs (NSAIDs), a large new Canadian study has found.
This study, published online on 29 May in the Lancet (www.thelancet.com), was funded by the Canadian Institutes of Health Research.
揙ur findings suggest significant differences between non-selective NSAIDs and individual COX 2 inhibitors with respect to risk of admission for congestive heart failure,?said the study抯 lead author, Professor Muhammad Mamdani, assistant professor in clinical epidemiology and healthcare research, at the Institute for Clinical Evaluative Sciences in Toronto, Canada.
揟he clinical relevance of these findings, in view of the widespread use of the drugs, warrants the implementation of large scale randomised controlled trials to examine this issue further,?he said.
In this population based retrospective cohort study, researchers compared the rates of hospital admission for congestive heart failure in elderly patients (aged 66 years or older) who had been prescribed COX 2 inhibitors or non-selective NSAIDs. They identified individuals who had been never used NSAIDs before and who had been started on celecoxib (18 908), the COX 2 inhibitor rofecoxib (14 583), and non-selective NSAIDs such as ibuprofen or naproxen (5391). They used 100 000 randomly selected individuals not using NSAIDs as a control group.
Compared with non-NSAID users, patients who had taken rofecoxib had an 80% increase in hospital admission for heart failure. Those who had used non-selective NSAIDs had a 40% increased risk. Risk of hospital admission among users of celecoxib, however, was the same as among people who had never used NSAIDs.
Although the estimated absolute risks of admission were small in those with no recent history of heart failure, the low estimated 搉umber needed to treat to harm?in those with a recent history makes these findings clinically relevant, say Professor Mamdani and his colleagues.
Another clinically important finding was that all drug groups were associated with a significantly increased risk of start of treatment for hypertension or congestive heart failure in those not previously on such treatment.
COX 2 inhibitors, which were marketed on the basis of being safer than the older traditional NSAIDs, have been met with extremely rapid and widespread acceptance, said Professor Mamdani. They may well be safer with respect to gastrointestinal symptoms, but they are not completely benign, he suggested. 揟hey do have serious adverse events of their own. More judicious prescribing may be warranted.?/p>
Although the study抯 findings were limited to an elderly population, they are likely applicable to a wider population, added Professor Mamdani. He said there should be caution when using NSAIDs in the general population, particularly in patients who have pre-existing heart failure. Careful monitoring of cardiovascular effects was needed for patients using celecoxib, rofecoxib, or non-selective NSAIDs, he added.(Toronto Barbara Kermode-S)
This study, published online on 29 May in the Lancet (www.thelancet.com), was funded by the Canadian Institutes of Health Research.
揙ur findings suggest significant differences between non-selective NSAIDs and individual COX 2 inhibitors with respect to risk of admission for congestive heart failure,?said the study抯 lead author, Professor Muhammad Mamdani, assistant professor in clinical epidemiology and healthcare research, at the Institute for Clinical Evaluative Sciences in Toronto, Canada.
揟he clinical relevance of these findings, in view of the widespread use of the drugs, warrants the implementation of large scale randomised controlled trials to examine this issue further,?he said.
In this population based retrospective cohort study, researchers compared the rates of hospital admission for congestive heart failure in elderly patients (aged 66 years or older) who had been prescribed COX 2 inhibitors or non-selective NSAIDs. They identified individuals who had been never used NSAIDs before and who had been started on celecoxib (18 908), the COX 2 inhibitor rofecoxib (14 583), and non-selective NSAIDs such as ibuprofen or naproxen (5391). They used 100 000 randomly selected individuals not using NSAIDs as a control group.
Compared with non-NSAID users, patients who had taken rofecoxib had an 80% increase in hospital admission for heart failure. Those who had used non-selective NSAIDs had a 40% increased risk. Risk of hospital admission among users of celecoxib, however, was the same as among people who had never used NSAIDs.
Although the estimated absolute risks of admission were small in those with no recent history of heart failure, the low estimated 搉umber needed to treat to harm?in those with a recent history makes these findings clinically relevant, say Professor Mamdani and his colleagues.
Another clinically important finding was that all drug groups were associated with a significantly increased risk of start of treatment for hypertension or congestive heart failure in those not previously on such treatment.
COX 2 inhibitors, which were marketed on the basis of being safer than the older traditional NSAIDs, have been met with extremely rapid and widespread acceptance, said Professor Mamdani. They may well be safer with respect to gastrointestinal symptoms, but they are not completely benign, he suggested. 揟hey do have serious adverse events of their own. More judicious prescribing may be warranted.?/p>
Although the study抯 findings were limited to an elderly population, they are likely applicable to a wider population, added Professor Mamdani. He said there should be caution when using NSAIDs in the general population, particularly in patients who have pre-existing heart failure. Careful monitoring of cardiovascular effects was needed for patients using celecoxib, rofecoxib, or non-selective NSAIDs, he added.(Toronto Barbara Kermode-S)