What are the risks of long-term NSAIDs and COX-2 inhibitors?
This review presents an interesting new analysis of cyclo-oxygenase-2 (COX-2) inhibitor safety, concluding that long-term use results in more serious adverse events than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). The nonsystematic and retrospective properties of this analysis limit its validity. However, the fact that an evaluation of long-term data found some small harm to COX-2 inhibitors relative to traditional NSAIDs (number needed to harm=78 over 9 months) should give clinicians pause. Until better meta-analyses or new safety data are published, clinicians should prescribe COX-2 inhibitors long-term only for those patients deemed to be at high risk of ulcer complications.
DeBisschop
Michael
M
University of Wyoming Family Practice Residency, Casper, USA. medrx@uwyo.edu
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008565:Membrane Proteins; D010003:Osteoarthritis / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D011451:Prostaglandin-Endoperoxide Synthases; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases