AHA: One COX-2 Has Heart Risk Similar to Naproxen in Study
Merck-funded, randomized trial conducted in osteoarthritis, rheumatoid arthritis patients
MONDAY, Nov. 13 (HealthDay News) -- A randomized trial suggests that one COX-2 inhibitor, etoricoxib, may be no more likely to cause thrombotic cardiovascular events than diclofenac when used to treat osteoarthritis or rheumatoid arthritis patients, according to an industry-funded report presented at the American Heart Association's Scientific Sessions in Chicago and published online Nov. 13 in The Lancet. In addition, etoricoxib may be less likely to cause upper gastrointestinal events, such as perforations, ulcers and bleeding.
Christopher Cannon, M.D., of Brigham and Women's Hospital in Boston, presented the results of the MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-term) program. In the study, 34,701 patients were randomized to etoricoxib at 60 mg/day (osteoarthritis) or 90 mg/day (osteoarthritis or rheumatoid arthritis) for a mean of 18 months, or diclofenac at 150 mg/day. Half of patients took a proton pump inhibitor and one-third took aspirin.
There were no significant differences between the drugs in terms of fatal thrombotic cardiovascular events (hazard ratio, 0.96), cardiac events (HR, 0.90), cerebrovascular events (HR, 1.08) or peripheral events (HR, 0.92). Confirmed upper gastrointestinal events were lower in the etoricoxib group (HR, 0.69).
Although other studies have found that etoricoxib can increase the risk of cardiovascular events, those studies were observational, said Cannon. In response to the trial, the AHA issued a statement that said, "Current evidence indicates that selective COX-2 inhibitors have important adverse cardiovascular effects including increased risk for heart attack, stroke, heart failure and hypertension."
The trial was sponsored by Merck.