Tuesday, 15 Oct 2019

You are here

Low Short-Term Risks of NSAIDs in High Risk Patients

JAMA has published a large Canadian claims-based study showing that nonsteroidal anti-inflammatory drug (NSAID) use in patients with hypertension, heart failure, or chronic kidney disease was not associated with a significant safety risk - but this only looked at short-term outcomes (7-37 days of exposure). 

A study of 2,415,291 musculoskeletal-related primary care visits and 814,049 older adults (mean age 75.3 years) who also had hypertension, heart failure, or CKD, found that nearly 10% were prescribed NSAID therapy.

A match cohort analysis (35 552 matched pairs of NSAID exposed and nonexposed) showed similar rates of cardiac complications (0.8% vs 0.8%), renal complications (0.1% vs 0.1%), and death (0.1% vs 0.1%).

Thus, even though NSAIDs were frequently used in high-risk patients, NSAID exposure was not associated with increased risk of short-term, safety-related outcomes.

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

Rheumatologists' Comments

Unfortunately, this data can be misinterpreted. In clinical practice painful conditions are not usually acute and short-term (exceptly secondary to overuse/ trauma). Instead it is not uncommon to be chronic and recurrent. Therefore, although short-term NSAIDs use appears to be safe in CKD, heart failure, and hypertension patients, its recurrent use can not be considered safe. I believe that, just like opioid abuse, anti-inflammatory abuse should be tackled and even if it proves to be safe in some situations, its use should be discouraged through constant patient education, reinforcing them to not “autoprescribe” NSAIDs.

More Like This

Hydroxychloroquine Blood Levels May Predict Future Retinopathy

A study of 527 patients receiving daily hydroxychloroquine (HCQ) concluded that hydroxychloroquine blood levels may predict future HCQ retinopathy.

This study assessed whether lower HCQ dosing, as recommended by the 2016 American Academy of Ophthalmology (AAO) guidelines (less than 5 mg/kg), would favorably affect retinopathy outcomes.

Arthritis Foundation Releases First CBD Guidance for Adults With Arthritis

As the leading organization for people with arthritis, the Arthritis Foundation has just released the first CBD guidance for adults with arthritis. CBD, or cannabidiol, a plant-based compound, has become popular among people with arthritis seeking to ease chronic joint pain.

Persistent Inflammatory Arthritis After Immune Checkpoint Inhibitors

Braaten and colleagues from Johns Hopkins School of Medicine have reported their experience with chronic inflammatory arthritis induced by immune checkpoint inhibitor therapies, showing that in some, inflammatory arthritis persists after the immunotherapy has been discontinued.

Checkpoint Inhibitors: Who Gets Myocarditis?

The usual risk factors for myocarditis may not apply to who gets it while on immune checkpoint inhibiting cancer drugs, an FDA adverse event database suggested.

NSAIDs Mediate Cardiovascular Risk in OA

NSAIDs have been linked to an increased risk of cardiovascular disease, but does this also hold for osteoarthritis (OA) patients.