Cardiac Risk With COX-2 Inhibitors is Not Uniquely Elevated
More recently evidence has been discovered suggesting that most NSAIDs, whether they are selective COX-2 blockers or not, may increase cardiovascular risk.
At the AHA Scientific Sessions in Chicago today, investigators revealed the results of the MEDAL trial, a randomized, head-to-head comparison of etoricoxib (the purest COX-2 inhibitor on the market, available in virtually every country in the world except the U.S.) and declofenac (Voltaren, the most widely prescribed NSAID on the market). The drugs were assigned randomly to patients over 50 years of age who had reasons to be on chronic NSAIDs, who were then followed for up to 3 years (average 18 months).
Data collected in the MEDAL trial showed no hint of any difference whatsoever in the risk of cardiac events, heart attack or stroke in patients taking etoricoxib vs. diclofenac. Patients in both groups had equal pain relief, but those on the selective COX-2 inhibitor had significantly fewer gastrointestinal side effects and liver function abnormalities than those on diclofenac. Selective COX-2 inhibition itself, therefore, is not associated with a uniquely increased risk of cardiovascular events, and, as designed, it does indeed reduce gastrointestinal side effects. You still can't have any, though.
Comments
Your article is misleading. In fact Cox-2 inhibitors cause an increased risk for heart attacks. When compared with each other the risk is no different.
I believe that the public deserves to know that this drug can cause them to have an increased risk and your article misleads them in thinking that the drugs were compared with non-cox-2 inhibitors and that was not the purpose of this study.
Investigators found that etoricoxib met the prespecified primary endpoint, showing a 0.95 relative risk of confirmed thrombotic cardiovascular events between it and diclofenac.
http://www.orthosupersite.com/default.asp?page=view&rid=19507
In a large-scale study, patients treated with the investigational selective COX-2 inhibitor etoricoxib showed similar rates of confirmed thrombotic cardiovascular events compared to patients treated with diclofenac, the most commonly used NSAID.
The preliminary findings were presented
The MEDAL program focused on performing a noninferiority analysis of confirmed thrombotic cardiovascular events following 18 months of daily treatment with either 60 mg or 90 mg of etoricoxib (Arcoxia, Merck) compared with 150 mg of diclofenac in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), according to the release.
Investigators found that etoricoxib met the prespecified primary endpoint, showing a 0.95 relative risk of confirmed thrombotic cardiovascular events between it and diclofenac. and major bleeding.
Among the 34,701 patients enrolled, 17,412 received etoricoxib and 17,289 received diclofenac. In the primary analysis, 320 etoricoxib patients and 323 diclofenac patients experienced thrombotic cardiovascular events.
The most common thrombotic cardiovascular events included heart attacks at a rate of 0.43 per 100 patient years for etoricoxib and 0.49 for diclofenac. Both groups also had a similar rate of fatal thrombotic cardiovascular events, averaging 0.17 per 100 patient years, according to the release.
In conclusion, controlled data from observational and randomized studies confirm a dose-related risk of cardiovascular events with selective COX-2 inhibitors. The observational data indicate that the risk increases early in treatment. An older NSAID, diclofenac, seems to share this risk and, unlike celecoxib, it appears to be harmful at commonly used doses. We believe there are grounds for reviewing its regulatory status.”
http://www.sciencedaily.com/releases/2006/09/060915203524.htm