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Selectivity of NSAIDs for COX‐2 and cardiovascular outcome
Author(s) -
Maxwell S. R. J.,
Payne R. A.,
Murray G. D.,
Webb D. J.
Publication year - 2006
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2006.02620.x
Subject(s) - medicine , observational study , nonsteroidal , odds ratio , randomized controlled trial , adverse effect , cyclooxygenase , pharmacology , chemistry , enzyme , biochemistry
Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) with increased selectivity for the cyclooxygenase‐2 (COX‐2) isoform reduce gastrotoxicity but may increase adverse cardiovascular events. Methods We searched the literature for studies that reported the odds ratio (OR) for such events following exposure to NSAIDs. Results For studies comparing NSAID use with no use, increased COX‐2 selectivity was significantly related to cardiovascular risk (log OR) amongst observational studies ( R = −0.34, P < 0.001) and randomized controlled trials (RCTs) ( R = −0.56, P < 0.001). For studies comparing NSAIDs, difference in selectivity was related to risk for observational studies ( R = −0.28, P = 0.005) but not for RCTs ( R = −0.23, P = 0.15). Conclusions Although increased COX‐2 selectivity may reduce gastrotoxicity, this may be at the cost of increasing cardiovascular risk.