Meta-analysis of clinical trials involving COX-2 inhibitors and cardiovascular outcomes conducted by investigators not associated with the pharmaceutical manufacturers were published after the market with-drawal of rofecoxib.
META-ANALYSIS OF COX-2
INHIBITORS AND CARDIOVASCULAR OUTCOMES
Meta-analysis
of clinical trials involving COX-2 inhibitors and cardiovascular outcomes
conducted by investigators not associated with the pharmaceutical manufacturers
were published after the market with-drawal of rofecoxib. Jüni and colleagues
abstracted reported frequency of fatal or non-fatal myocardial infarction from
18 clinical trials of rofecoxib among patients with rheumatoid arthritis,
osteoarthritis, or back pain (Jüni et al.,
2004). Rofecoxib dosage ranged from 12.5 to 50 mg per day and treatment
duration ranged from 4 to 56 weeks. The comparison groups received either
placebo or a non-selective NSAID. Approximately a third of the 25 573 patients
in the 18 trials were enrolled in VIGOR. In 10 of the 18 trials, myocardial
infarction was more common among the rofecoxib arm, but the difference only
reached statis-tical significance in VIGOR. The combined odds ratio for the
rofecoxib versus non-selective NSAID or placebo comparison was 2.24 (95% CI,
1.24–4.02).
Kearney
reviewed 138 randomized trials of either a COX-2 inhibitor versus placebo or a
COX-2 inhibitor versus non-selective NSAIDs and evalu-ated a range of
cardiovascular end points, including vascular events, myocardial infarction,
stroke, and vascular death (Kearney et
al., 2006). For all COX-2 inhibitors (celecoxib, etoricoxib, lumiracoxib,
rofe-coxib, and valdecoxib) as a group and compared with placebo, relative risk
of developing serious vascu-lar events was 1.42 (95% CI, 1.13–1.78).
Heteroge-neous results were observed when COX-2 inhibitors were compared with
different non-selective NSAIDs. COX-2 inhibitors were associated with increased
vascular risk when compared with naproxen (relative risk 1.57; 95% CI,
1.21–2.03) and were not associ-ated with increased vascular risk when compared
with non-naproxen NSAIDs (relative risk 0.88; 95% CI, 0.69–1.12).
For
other adverse cardiovascular outcomes, Aw and colleagues reviewed 19 clinical
trials involving COX-2 inhibitors and reported that use of COX-2 inhibitors was
associated with increased blood pressure when compared with placebo or
non-selective NSAIDs (Aw et al.,
2005). The effect on blood pressure was more
pronounced among rofecoxib users than among cele-coxib users. Zhang and
colleagues reviewed 114 clin-ical trials involving COX-2 inhibitors and found
that rofecoxib use was associated with increased risk of arrhythmia, peripheral
edema, hypertension, and renal dysfunction but celecoxib use was not associated
with increased risk of these events (Zhang, Ding and Song, 2006).
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