Therapeutics
Review: selective COX 2 inhibitors increase vascular events more than placebo and naproxen but not more than other NSAIDs
Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 2006;332:1302–8.
Q Do selective cyclo-oxygenase-2 (COX 2) inhibitors increase risk of serious vascular events more than placebo or traditional non-steroidal anti-inflammatory drugs (NSAIDs)?
IM/Ambulatory care Haematology Rheumatology
Key Words: anti-inflammatory agents (non-steroidal) • atherosclerosis • cyclo-oxygenase 2 inhibitors • thrombosis
| The first 150 words of the full text of this article appear below. |
Data sources:
Medline and EMBASE/Excerpta Medica (1966 to April 2005), US Food and Drug Administration website, and drug manufacturers.
Study selection and assessment:
randomised controlled trials (RCTs) 
4 weeks in duration that compared a selective COX 2 inhibitor with placebo or a traditional NSAID. 138 RCTs (n = 145 373) met the selection criteria. Investigators and manufacturers provided details on the number of vascular events and person time at risk.
Outcomes:
myocardial infarction (MI), stroke, and vascular death, and a composite end point of all vascular events.
Selective COX 2 inhibitors increased risk of all vascular events and MI, but not stroke (table
) or vascular death, more than placebo and naproxen. COX 2 inhibitors and non-naproxen NSAIDs did not differ for all vascular events, MI (table), or vascular death. Risk of stroke was lower with COX 2 inhibitors (table). When data from indirect and direct comparisons were
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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