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Meta-Analysis Finds COX-2 Inhibitors, NSAID Risk Similar

Myocardial infarction is most likely adverse event but overall risk is modest

FRIDAY, June 2 (HealthDay News) -- Selective COX-2 inhibitors and high doses of some traditional nonsteroidal anti-inflammatory drugs (NSAIDs) carry similar risks of cardiovascular events such as myocardial infarction, according to a meta-analysis published in the June 3 issue of BMJ.

Colin Baigent, M.D., of the University of Oxford in the U.K., and colleagues conducted a meta-analysis of 138 trials comprising over 145,000 patients in which selective COX-2 inhibitors were compared with either placebo or traditional NSAIDs.

Compared with placebo, selective COX-2 inhibitors had a 42 percent higher incidence of serious vascular events (1.2 percent per year versus 0.9 percent). In addition, the risk of myocardial infarction was lower with placebo than a COX-2 inhibitor (0.3 percent versus 0.6 percent). However, studies comparing COX-2 inhibitors with NSAIDs found similar incidence rates for the two types of drugs, although naproxen did not carry any additional risk.

"Selective COX-2 inhibitors are associated with a moderate increase in the risk of vascular events, as are high-dose regimens of ibuprofen and diclofenac, but high-dose naproxen is not associated with such an excess," the authors write. "The available data from placebo-controlled trials were inadequate to allow assessment of whether the cardiovascular risks of selective COX-2 inhibitors are dose dependent."

An accompanying editorial examines the various options for pain relief and recommends physicians think creatively and work with patients to choose the best method for treatment of chronic pain.

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