title: Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine whether the increased risk of cardiovascular events with rofecoxib represents a class effect of cyclooxygenase-2 (COX-2) specific inhibitors.
  
  
  METHODS
  Systematic review and meta-analysis of randomized double-blind clinical trials of celecoxib of at least 6 weeks' duration and presented data on serious cardiovascular thromboembolic events. Data sources included six bibliographic databases, the relevant files of the United States Food and Drug Administration, and pharmaceutical company websites.
  
  
  METHODS
  Pooled fixed effects estimates of the odds ratios for risk of cardiovascular events with celecoxib compared with comparator treatment were calculated using the inverse variance weight method. The main outcome measure was myocardial infarction.
  
  
  RESULTS
  Four placebo-controlled trials with 4422 patients were included in the primary meta-analysis comparing celecoxib with placebo. The odds ratio of myocardial infarction with celecoxib compared to placebo was 2.26 (95%confidence interval 1.0 to 5.1). For composite cardiovascular events [odd ratio 1.38 (95% CI 0.91 to 2.10)], cardiovascular deaths [OR 1.06 (95% CI 0.38 to 2.95)] and stroke [OR 1.0(95% CI 0.51 to 1.84)] there was no significant increase in risk with celecoxib. The secondary meta-analysis which included a total of six studies (with placebo, diclofenac, ibuprofen, and paracetamol as comparators) of 12 780 patients, showed similar findings with a significant increased risk with celecoxib for myocardial infarction [OR 1.88 (95% CI 1.15 to 3.08)] but not other outcome measures.
  
  
  CONCLUSIONS
  The available data indicate an increased risk of myocardial infarction with celecoxib therapy, consistent with a class effect for COX-2 specific inhibitors.
authors.affiliation: Medical Research Institute of New Zealand, Wellington, NZ.
authors.forename: Brent
authors.initials: B
authors.lastname: Caldwell
authors.forename: Sarah
authors.initials: S
authors.lastname: Aldington
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Philippa
authors.initials: P
authors.lastname: Shirtcliffe
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
mesh_terms: D002318:Cardiovascular Diseases / Q000139:chemically induced*; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D006801:Humans; D011379:Prognosis; D011720:Pyrazoles / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects*
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib