Friday, 24 Jan 2020

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

Best of 2019 - Biologic Safety Guidelines from the British Society for Rheumatology

In the United Kingdom, NICE has looked to the British Society of Rheumatology (BSR) to develop evidence based guidance on the safe use of biologic DMARDs in patients with inflammatory arthritis. This guidance document on biologic safety covers baseline screening, monitoring, effect of co-morbidities, and when or under what circumstances biologic therapy should be interrupted.

Best of 2019 - Methotrexate and the Risk of Lung Disease

Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.

No Cancer Risk with Systemic Necrotizing Vasculitis

The French Vasculitis Study Group has published that patients with systemic necrotizing vasculitis do not have an increased risk of malignancy; in fact they have a risk that is similar to the general population.

Previous reports have suggested either no risk or a declining risk in the era of better therapies for vasculitis. 

FDA Warns 15 CBD Manufacturers

Today, the U.S. Food and Drug Administration issued warning letters to 15 companies for illegally selling products containing cannabidiol (CBD) in ways that violate the Federal Food, Drug, and Cosmetic Act (FD&C Act).  This warning affirms that the FDA has not determined the many preparations of cannabidiol to be safe or effective.

Biologic Safety Guidelines from the British Society for Rheumatology

In the United Kingdom, NICE has looked to the British Society of Rheumatology (BSR) to develop evidence based guidance on the safe use of biologic DMARDs in patients with inflammatory arthritis. This guidance document on biologic safety covers baseline screening, monitoring, effect of co-morbidities, and when or under what circumstances biologic therapy should be interrupted.