Celecoxib and sulfasalazine had negative association with coronary artery diseases in patients with ankylosing spondylitis: A nation-wide, population-based case-control study.
The aim of the study is to assess the effects of celecoxib and sulfasalazine on the risk of coronary artery disease (CAD) in patients with ankylosing spondylitis (AS).Using the claims data of Taiwan National Health Insurance (NHI) database, a nationally representative data that contain the medical records of 23 million Taiwan residents, we randomly selected 1 million cohort from the database, and then we enrolled only patients who were newly diagnosed with AS (n = 4829) between year 2001 and 2010, excluding patients who had CAD (ICD-9- CM codes: 410-414) before the diagnosis of AS (n = 4112). According to propensity score matched 1:2 on age, gender, AS duration, Charlson comorbidity index, hypertension, and hyperlipidemia, 236 and 472 patients were included in the case (AS with CAD) and control (AS without CAD) groups, respectively. We used the WHO defined daily dose (DDD) as a tool to assess the dosage of sulfasalazine and celecoxib exposure. Conditional logistic regression was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidence interval (CI) for the risk of CAD associated with use of sulfasalazine and celecoxib.Among 4112 AS patients, 8.4% (346/4112) developed CAD. CAD in AS patients were positively associated with age of 35 to 65, Charlson comorbidities index (CCI), hypertension, and hyperlipidemia. There was no gender difference between case and control groups. After adjustment for age, gender, CCI, hypertension, and hyperlipidemia, sulfasalazine users with an average daily dose ≥ 0.5 DDD (0.5 gm/day) had negative association with CAD events as compared to sulfasalazine nonusers (OR 0.63; 95% CI, 0.40-0.99, P < 0.05). NSAIDs, including celecoxib, etoricoxib, but no naproxen and diclofenac were negatively associated with CAD. Celecoxib users, with an average daily dose > 1.5 DDD, were negatively associated with CAD events, compared to celecoxib nonusers (OR 0.34; 95% CI, 0.13-0.89; P < 0.05).In this 10-year population-based case-control study, 8.4% of AS patients developed CAD. Sulfasalazine usage at an average dose of ≥ 0.5 gm/day demonstrated negative association with CAD events in patients with AS.
Institute of Medicine, Chung Shan Medical University Division of Allergy, Immunology and Rheumatology, Institute of Medicine, Chung Shan Medical University Department of Medical Research, Chung Shan Medical University Hospital Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital; Institute of Medicine, Chung Shan Medical University; Institute of Integrative Medicine, China Medical University, Taichung, Taiwan, No.110, Sec.1, Jianguo N. Rd., Taichung City 40201, Taiwan School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan.
Li-Chih
LC
Wu
Pui-Ying
PY
Leong
Kai-Jieh
KJ
Yeo
Ting-Yu
TY
Li
Yu-Hsun
YH
Wang
Jeng-Yuan
JY
Chiou
James Cheng-Chung
JC
Wei
D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D000068579:Celecoxib / Q000008:administration & dosage / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000453:epidemiology*; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D065840:Protective Factors; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D012460:Sulfasalazine / Q000008:administration & dosage / Q000627:therapeutic use*; D013624:Taiwan / Q000453:epidemiology
D018501:Antirheumatic Agents; D052246:Cyclooxygenase 2 Inhibitors; D012460:Sulfasalazine; D000068579:Celecoxib