Friday, 22 Jun 2018

You are here

Equal Cardiovascular Risks in Hypertensive Patients Treated with Selective and Nonselective NSAIDS

A Taiwanese study of 55,629 hypertensive patients shows no increased risk of  major cardiovascular events comparing outcomes of patients started on COX-2 selective NSAIDs compared with nonselective NSAIDs (including ibuprofen, diclofenac and naproxen).

This was a cohort study comparing hypertensive patients starting COX-2 selective NSAIDs or nonselective NSAIDs form Taiwan.  The outcomes of interest were major cardiovascular events of hospitalization for ischemic stroke, acute myocardial infarction, congestive heart failure, transient ischemic attack, unstable angina, or coronary revascularization. Patients were only followed for up to 4 weeks. 

Comparison groups included 2,749 eligible COX-2 selective NSAID users and 52,880 eligible nonselective NSAID users.

The HR of major cardiovascular events comparing COX-2 selective NSAIDs to nonselective NSAIDs after adjusting for baseline and time-varying covariates was 1.07 (95% CI, 0.65-1.74). The results were the same when comparing celecoxib to to diclofenac (HR, 1.17; 95% CI, 0.61-2.25), ibuprofen (HR, 1.36; 95% CI, 0.58-3.18), or naproxen (HR, 0.75; 95% CI, 0.23-2.44). There was an increased risk with COX-2 selective NSAIDs, however, when comparing COX-2 to mefenamic acid (HR, 2.11; 95% CI, 1.09-4.09).

These data mirror that seen in the recent completed PRECISION study. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

NSAID Use Around Conception Increases Miscarriage Risk

A study from the American Journal of Obstetrics & Gynecology analyzed pregnant women from the Kaiser Permanente healthcare system and compared newly pregnant women who took non-steroidal anti-inflammatory drugs or acetaminophen or neither showed that using NSAIDs around conception carried a more than four-fold higher risk of early miscarriage. (Citation source: http://bit.ly/2tqNWN6)

Could Measuring Drug Levels with TNF Treatment Hurt Your Patients?

Our colleagues in gastroenterology measure drug levels with certain biologics used in inflammatory bowel disease in order to increase the dose for optimal benefit if the patient has a low trough level (i.e. targeting drug level).

There have been GI trials with T2T with drug levels but they are not always suggesting that the strategy is superior to usual care. Also, this is really not a common practice in rheumatology.

Methotrexate Update

I was delighted to see that investigators presenting work at EULAR 2018 haven’t lost interest in our old friend methotrexate, with a number of abstracts examining issues of safety, dose and route of administration.

Low incidence of methotrexate induced liver abnormalities

Cancer Therapies Inducing Immune-Related Adverse Events (irAEs)

Recent shifts in the cancer treatment paradigm towards immune therapies has led to wide implementation of the novel immune check point inhibitors (ICI) in the treatment of multiple types of advanced cancer.

While being quite effective in oncology, these checkpoint inhibitors have led to the emergence of a quite unique spectrum of rheumatologic conditions presented under the umbrella of immune-related adverse events (irAEs).

Tobacco Associated Deaths in the USA

JAMA Internal Medicine reports that in the USA, those who smoke cigar, pipe, or cigarette have a significant overall  mortality risk, and a much highers cancer mortality risk compared to nonsmokers.

The National Longitudinal Mortality Study collected baseline survey data from 1985 through 2011 and included 357,420 participants reporting on their use of cigar, pipes, or cigarettes.