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Review: selective COX 2 inhibitors increase vascular events more than placebo and naproxen but not more than other NSAIDs

Clinical impact ratings GP/FP/Primary care 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.

METHODS
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.

MAIN RESULTS
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 . . . [Full text of this article]

Andreas Laupacis, MD

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada