26 May 2018

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Safety differences revealed for pain-relieving drugs combined with aspirin

WASHINGTON, April 16 (Xinhua) — A Cleveland Clinic study of widely used pain-relieving drugs showed that celecoxib was associated with comparable cardiovascular safety and better gastrointestinal (GI) and kidney safety when compared with either naproxen or ibuprofen.

The study, published on Monday in the Journal of the American College of Cardiology, analyzed outcomes based on the presence or absence of aspirin use with specific nonsteroidal anti-inflammatory drugs or NSAIDs.

The research showed that taking aspirin with celecoxib lessened celecoxib’s cardiovascular safety advantage, but celecoxib was still associated with fewer GI problems than either of the other drugs and fewer kidney issues than ibuprofen.

The decade-long trial studied osteoarthritis or rheumatoid arthritis patients who required daily prescription use of NSAIDs for pain relief. All participants had pre-existing heart disease or increased risk for developing heart disease, thereby using aspirin.

The researchers reviewed occurrences of major adverse cardiovascular events such as heart attack or stroke, non-cardiovascular death, clinically significant GI events, anemia of GI origin or serious renal events.

GI problems including ulcers or chronic bleeding are known complications of NSAIDs, and NSAIDs are also known to cause kidney complications.

The study followed nearly 24,000 patients with osteoarthritis or rheumatoid arthritis who were taking daily prescription doses of either celecoxib, naproxen or ibuprofen for a minimum of 18 months. Of those patients, 11,000 were also taking aspirin.

It showed that adding aspirin diminished some of the safety advantage for celecoxib as patients taking both had more of a risk for major adverse events compared to those on just celecoxib alone.

However, even with aspirin, celecoxib patients still had slightly less overall adverse outcomes than those taking ibuprofen with aspirin. There was not a significant overall difference between celecoxib and naproxen with aspirin.

In addition, celecoxib patients had fewer GI problems than ibuprofen or naproxen and fewer renal issues than ibuprofen.

“Past studies have reported conflicting results regarding using NSAIDs together with aspirin, but we know that many patients do combine the medications, so it was vital to understand the risks and differences among the drugs,” said Steve Nissen, chairman of Cardiovascular Medicine at Cleveland Clinic and the study’s principle investigator.

“The outcomes of this study could lead to changes in clinical practice. If a patient is not on aspirin, these results suggest that in many cases, celecoxib may be the NSAID of choice,” said Grant Reed, an interventional cardiology fellow at Cleveland Clinic, and the study’s first author.

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