Friday, 16 Feb 2018

You are here

NSAIDs Increase Risk of Acute Myocardial Infarction

Using data from Canadian and European healthcare databases, the BMJ has reported that all NSAIDs, including celecoxib and naproxen, increase the risk of acute myocardial infarction.

While the recent 24,081 patient PRECISION study showed noninferiority between celecoxib, naproxen and ibuprofen with regard to CV risk, that study did not include a placebo arm.

Canadian researchers examined computerised drug prescription or medical databases for the use of selective COX-2 inhibitors (including rofecoxib) and traditional NSAIDs, and looked at the risk of acute myocardial infarction (AMI) in NSAID users with non-users.

 The cohort included 61,460 AMI cases and 385 303 controls (total of 446 763) who were receiving NSAIDs for one week, one month, or more than a month.

The risk of AMI immediately increased with NSAID exposure. Thus, with 1-7 days of NSAID use, AMI risk was significantly increased (with an adjusted odds ratio >1.0) for celecoxib (OR 1.24), ibuprofen (OR 1.48), diclofenac (OR 1.50), naproxen (OR 1.53), and rofecoxib (OR 1.58).

While higher doses were associated with greater risk of myocardial infarction, longer use risk did did exceed risks seen with shorter durations.

Conclusions All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.

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

Rheumatologists' Comments

1) a meta analysis of observational studies. Not very trustworthy. 2) CONFOUNDING
You hit the nail on the head. This is not novel, new or insightful data. It does little to shed light on a rare association. But because this is getting prominent play in the news, I posted the report for all to be aware, and hopefully look with a discriminating eye; as you have done. Thanks JJC

More Like This

ACIP Guidelines on H. Zoster Vaccination Updated

The ACIP has discussed and analyzed its VZV vaccination policy to ensure safety and reduce disease burden. This report serves as a supplement to the 2008 Prevention of Herpes Zoster Recommendations.

Herpes zoster is a localized, usually painful, cutaneous eruption resulting from reactivation of latent varicella zoster virus (VZV). Herpes zoster is common: approximately one million cases occur each year in the United States.

Higher Fracture Risk with PMR and GCA

Corticosteroid therapy is integral to the treatment of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) and a new retrospective cohort study from the UK shows that PMR and GCA have similar, increased risk of fractures.

Problems with Biologic Drug Storage

Is your patient’s refrigerator the problem with the inefficacy of biologic therapies? Studies show most patients don't store their biologics correctly, which may be a source of limited drug efficacy.

Prevention of HBV Infection: How Are We Doing?

In 2016 the WHO set out to eliminate HBV infection as a public health threat by 2030. So far, we are far from this goal as vaccine implementation has been suboptimal in a number of important patient populations, including patients with rheumatologic diseases, as well as other immunocompromising diseases like HIV.

B Cell Changes Predict Autoimmunity with Checkpoint Inhibitors

The Journal of Clinical Investigation reports results of a study showing that increases in CD21lo B cells and plasmablasts following that combination checkpoint blockade preceded the onset of immune-related adverse events.

While some have postulated that IRAEs are thought to be T cell mediated, B cells have also been implicated. Investigators studied 39 melanoma patients undergoing treatment with either anti-CTLA4 or anti-PD1, or combination CCB therapy. They analyzed changes in circulating B cells before and after the first cycle of therapy of immune checkpoint blockade (23 received combination therapy, 8 received anti-CTLA4, and 8 received anti-PD1).