Wednesday, 21 Aug 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.

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

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.

Tofacitinib Gets a New Boxed Warning for Blood Clots and Death with Higher Doses

The U.S. Food and Drug Administration has approved new warnings about an increased risk of blood clots and of death with the 10 mg twice daily dose of tofacitinib (Xeljanz, Xeljanz XR), which is used in patients with ulcerative colitis. 

EHR-Related Adverse Events Usually Involve Medications

Concerns about the unintended risks inherent in electronic health records (EHR) by analysis of EHR–related harms identified from large database of malpractice suits and claims; they found that EHR related adverse events exist, and may be associated with an severe harms and uncommonly, death.

Methotrexate Use Not Linked to Interstitial Lung Disease in RA

People with rheumatoid arthritis have a significant risk of developing interstitial lung disease (RA-ILD), yet there is often a question as to whether methotrexate (MTX) exposure can cause or worsen ILD.  A controlled cohort study suggests that MTX use is not associated with an increased risk of RA-ILD and instead, there is evidence suggesting MTX use may delay the onset of ILD.

FDA Adds Boxed Warning to Sleep Drugs

The Food and Drug Administration (FDA) added a Boxed Warning to several sleep medications (e.g., eszopiclone, zaleplon, and zolpidem), warning rare but serious injuries may occur as a result of abnormal sleep behaviors (sleepwalking, sleep driving, and engaging in other activities while not fully awake) when taking sleep medications. These complex sleep behaviors have also resulted in deaths.