Skip Navigation


Rheumatology Advance Access originally published online on January 25, 2007
Rheumatology 2007 46(3):435-438; doi:10.1093/rheumatology/kel428
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
46/3/435    most recent
kel428v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (5)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Rahme, E.
Right arrow Articles by Nedjar, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rahme, E.
Right arrow Articles by Nedjar, H.
Related Collections
Right arrow Rehabilitation
Right arrow Psychology: Measurement and Management of Pain
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Risks and benefits of COX-2 inhibitors vs non-selective NSAIDs: does their cardiovascular risk exceed their gastrointestinal benefit? A retrospective cohort study

E. Rahme1,2 and H. Nedjar2

1Department of Medicine and 2Research Institute, McGill University Health Centre, Montreal, Canada.

Correspondence to: E. Rahme, Division of Clinical Epidemiology, McGill University Health Centre, Division of Clinical Epidemiology (V), 687 Pine Avenue West, V Building Montreal, Quebec Canada, H3A 1A1. E-mail: elham.rahme{at}mcgill.ca


  Abstract

Objectives. The risk of acute myocardial infarction (AMI) with COX-2 inhibitors may offset their gastrointestinal (GI) benefit compared with non-selective (NS) non-steroidal anti-inflammatory drugs (NSAIDs). We aimed to compare the risks of hospitalization for AMI and GI bleeding among elderly patients using COX-2 inhibitors, NS-NSAIDs and acetaminophen.

Methods. We conducted a retrospective cohort study using administrative data of patients ≥65 years of age who filled a prescription for NSAID or acetaminophen during 1999–2002. Outcomes were compared using Cox regression models with time-dependent exposures.

Results. Person-years of exposure among non-users of aspirin were: 75 761 to acetaminophen, 42 671 to rofecoxib 65 860 to celecoxib, and 37 495 to NS-NSAIDs. Among users of aspirin, they were: 14 671 to rofecoxib, 22 875 to celecoxib, 9 832 to NS-NSAIDs and 38 048 to acetaminophen. Among non-users of aspirin, the adjusted hazard ratios (95% confidence interval) of hospitalization for AMI/GI vs the acetaminophen (with no aspirin) group were: rofecoxib 1.27 (1.13, 1.42), celecoxib 0.93 (0.83, 1.03), naproxen 1.59 (1.31, 1.93), diclofenac 1.17 (0.99, 1.38) and ibuprofen 1.05 (0.74, 1.51). Among users of aspirin, they were: rofecoxib 1.73 (1.52, 1.98), celecoxib 1.34 (1.19, 1.52), ibuprofen 1.51 (0.95, 2.41), diclofenac 1.69 (1.35, 2.10), naproxen 1.35 (0.97, 1.88) and acetaminophen 1.29 (1.17, 1.42).

Conclusion. Among non-users of aspirin, naproxen seemed to carry the highest risk for AMI/GI bleeding. The AMI/GI toxicity of celecoxib was similar to that of acetaminophen and seemed to be better than those of rofecoxib and NS-NSAIDs. Among users of aspirin, both celecoxib and naproxen seemed to be the least toxic.

KEY WORDS: Non-steroidal antiinflammatory drugs, COX-2 inhibitors, Acetaminophen, Acute myocardial infarction, Gastrointestinal bleeding, Elderly patients, Administrative database, Retrospective cohort

Submitted 16 August 2006; revised version accepted 30 November 2006.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.