The risk of acute myocardial infarction with etodolac is not increased compared to naproxen: a historical cohort analysis of a generic COX-2 selective inhibitor.
BACKGROUND
This study compares the risk of acute myocardial infarction among patients exposed to etodolac, naproxen, celecoxib, and rofecoxib.


METHODS
A retrospective cohort study in 38 258 veteran patients (26 376 patient-years) measured the adjusted odds ratios of acute myocardial infarction during exposure to etodolac, naproxen, celecoxib, or rofecoxib.


RESULTS
Diagnosis of acute myocardial infarction was confirmed in 100 patients who were exposed to a study nonsteroidal anti-inflammatory drug. Compared to naproxen, the increased risk of acute myocardial infarction was not significant for etodolac (OR = 1.32, P = .27), whereas celecoxib (OR = 2.18, 95% CI 1.09-4.35, P = .03) and rofecoxib (OR = 2.16, 95 CI 1.04-4.46, P = .04) were significant. A post hoc analysis indicates that patients with a prior history of acute myocardial infarction had a significant, 4.26-fold risk for another acute myocardial infarction if taking celecoxib or rofecoxib.


CONCLUSIONS
Etodolac is not associated with a statistically increased risk of acute myocardial infarction compared to naproxen.
Warner
John J
JJ
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, Texas 75390, USA. john.warner@utsouthwestern.edu
Weideman
Rick A
RA
Kelly
Kevin C
KC
Brilakis
Emmanouil S
ES
Banerjee
Subhash
S
Cunningham
Francesca
F
Harford
William V
WV
Kazi
Salahuddin
S
Little
Bertis B
BB
Cryer
Byron
B
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000068579:Celecoxib; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D016568:Drugs, Generic / Q000009:adverse effects; D017308:Etodolac / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007783:Lactones / Q000009:adverse effects; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D009288:Naproxen / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis; D011720:Pyrazoles / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects; D013450:Sulfones / Q000009:adverse effects; D013781:Texas / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016568:Drugs, Generic; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D017308:Etodolac; D009288:Naproxen; D000068579:Celecoxib