Cardiovascular events associated with long-term use of celecoxib, rofecoxib and meloxicam in Taiwan: an observational study.
BACKGROUND
Using national data (2001-2003), this study explored the risk of acute myocardial infarction (AMI), angina, stroke and transient ischaemic attack (TIA) in long-term users of rofecoxib and celecoxib in Taiwan and compared this data with that for those using meloxicam.


METHODS
Patients included in the study had used celecoxib, rofecoxib or meloxicam for at least 180 days. Data were taken from National Health Insurance database for the period from 2001 to 2003. Main outcome measurements were the occurrence of AMI, angina, stroke or TIA after the initiation of long-term continuous use of these drugs. Person-time exposures and hazard ratios (HRs) were calculated based on data from 9602 eligible patients.


RESULTS
In patients without a history of a cardiovascular event within the year before drug treatment began, the overall rates of AMI, angina, stroke and TIA were 1.1%, 0.6%, 2.0% and 0.6%, respectively. In those with cardiovascular events in the year before treatment began, the overall rates of AMI, angina, stroke and TIA were 5.0%, 4.8%, 6.6% and 5.8%, respectively. Compared with meloxicam users, celecoxib users had lower HRs for the development of AMI (HR 0.78, 95% CI 0.63, 0.96) and stroke (HR 0.81, 95% CI 0.70, 0.93). Rofecoxib users were at no higher risk of cardiovascular events than those receiving meloxicam. Regardless of treatment, having had a cardiovascular event in the year before treatment began played a significant role in the development of the same cardiovascular event during the prescription period; the HRs associated with having had the same cardiovascular event in the past year, versus not having had such an event, were 3.02 (95% CI 1.44, 6.32) for AMI, 5.82 (95% CI 3.19, 10.63) for angina, 2.44 (95% CI 1.79, 3.33) for stroke and 7.16 (95% CI 3.70, 13.87) for TIA.


CONCLUSIONS
Patients taking celecoxib had a lower risk of cardiovascular events than those taking meloxicam. Patients taking rofecoxib were not found to be at higher cardiovascular risk than those taking meloxicam. The most significant determinant of cardiovascular risk was a history of such cardiovascular disease in the year preceding treatment initiation. Patients with a history of other medical conditions also appeared to be at higher risk of adverse cardiovascular events.
Huang
Weng-Foung
WF
Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. huang@ym.edu.tw
Hsiao
Fei-Yuan
FY
Tsai
Yi-Wen
YW
Wen
Yu-Wen
YW
Shih
Yaw-Tang
YT
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000139:chemically induced / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D002546:Ischemic Attack, Transient / Q000139:chemically induced / Q000453:epidemiology; D007783:Lactones / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D000077239:Meloxicam; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology; D009313:National Health Programs; D016016:Proportional Hazards Models; D011720:Pyrazoles / Q000009:adverse effects* / Q000627:therapeutic use; D018570:Risk Assessment; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D013450:Sulfones / Q000009:adverse effects* / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology; D013843:Thiazines / Q000009:adverse effects* / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors
D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; D013843:Thiazines; D013844:Thiazoles; C116926:rofecoxib; D000068579:Celecoxib; D000077239:Meloxicam