COX-2 inhibitors risk "low" - study

Wednesday October 12th, 2016

A large study on the risks of different painkillers prescribed for arthritis has found no significant increase in risk with COX-2 inhibitors.

These drugs are just as safe as older, and commonly given non-steroidal anti-inflammatory drugs, say Professor Chris Hawkey of Nottingham University, UK, and colleagues.

The team explain that hospitalisation for upper gastrointestinal tract ulceration possibly due to non-steroidal anti-inflammatory drugs is a concern. Because of this, COX-2 inhibitors gained popularity because they had a lower risk, but they in turn carry a risk of cardiovascular disease.

Current guidelines warn against COX-2 inhibitors for people with established cardiovascular disease. But the team wanted to establish the true risk for people free of cardiovascular disease switching from their usual non-steroidal anti-inflammatory drug to the COX2 inhibitor celecoxib.

They recruited 7,297 participants aged 60 years and over with osteoarthritis or rheumatoid arthritis on non-steroidal anti-inflammatory drugs. Over the next three years, the rate of cardiovascular events was similar for those who stayed on non-steroidal anti-inflammatory drugs and those who changed to celecoxib.

Although more adverse reactions were reported on non-steroidal anti-inflammatory drugs, more patients withdrew from the celecoxib group.

In the European Heart Journal, the authors write: "There was no advantage of a strategy of switching prescribed non-steroidal anti-inflammatory drugs to prescribed celecoxib."

Professor Hawkey commented: "Although the trial was set up to investigate whether there are striking differences in the risk of cardiovascular or gastrointestinal problems, the striking feature is how low the incidence of such problems was.

"Although celecoxib is a good choice for safe prescribing, there is little value in switching patients from existing medication that they have acclimatised to."

MacDonald, T. M. et al. Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib: the Standard care vs. Celecoxib Outcome Trial (SCOT). European Heart Journal 4 October 2016 doi: 10.1093/eurheartj/ehw387

Tags: Heart Health | Pain Relief | Pharmaceuticals | Rheumatology | UK News

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