By inhibiting the production of PGs, as both nonselective NSAIDs and coxibs
do, these agents can exacerbate--and theoretically cause--fluid imbalance, electrolyte disorders and kidney problems during a marathon.
The CNT meta-analysis quantified the CV risk of coxibs
vs placebo by comparing a coxib
directly with placebo.
Mean follow-up time was 117 days for NSAIDs, 202 days for coxibs
, and 137 days for opioids.
The association of NSAIDs, especially COX2 inhibitors (coxibs
) with serious cardiovascular events, however, is a major public health concern.
But in a similar, 65-year-old patient, "I'd use a coxib
or add a proton pump inhibitor," he said.
Patients aged 40 years and older with a new episode of prescribed NSAID or coxib
use between 1996 and 2004 were included.
"For patients taking low-dose aspirin, it is hard to justify the coxib
: There is no benefit in ulcer complication reduction," said Eric J.
The study based on insurance company data looked at 14,001 patients who switched from chronic NSAID therapy to treatment with a coxib
. They were compared with 143,435 patients on chronic NSAID therapy and 372,640 individuals not on either type of drug.
He modeled 1 year of chronic arthritis therapy in 60-year-old patients, assuming a cost of $2.53 per tablet for a coxib
and $0.38 per tablet for naproxen.
Results of a large meta-analysis of randomized controlled trials have shown that diclofenac was associated with a risk of CV harm comparable to coxibs
when considered as a broad class .
In addition to looking at CV risk, the CNT analysis also examined upper GI complications (ie, upper GI bleeding and/or perforation, or peptic ulcer) and showed the risk to be nearly twice as high for ibuprofen and naproxen compared with diclofenac or a coxib
and traditional NSAID Trialists' (CNT) Collaboration, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al.