Selective COX-2 inhibitors, NSAIDS, aspirin, and myocardial infarction

Archives of Internal Medicine (Impact Factor: 17.33). 06/2002; 162(10):1091-2.
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    • "Five observational epidemiologic studies published in the past 2 years examined the effect of NSAIDs, particularly naproxen, on the risk of cardiovascular thrombotic events including myocardial infarction; these studies were reviewed recently by Strand and Hochberg [21]. The results of a majority of these studies are consistent with a modest protective effect of naproxen on the development of nonfatal myocardial infarction; indeed, Dalen, in his editorial accompanying the three papers published in the Archives of Internal Medicine, concluded that the most likely explanation of the results in the VIGOR trial was "that naproxen decreases the incidence of acute myocardial infarction" [22]. Patrono suggested that a combination of a protective effect of naproxen and the "play of chance" operating in a short-term study [median follow-up of 9 months] with small numbers of events in a low-risk population [event rate below 1% per year] explained the findings in the VIGOR trial (Patrono C, Invited Lecture on 28 October 2002 at annual meeting of American College of Rheumatology, New Orleans, LA). "
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    ABSTRACT: Cyclooxygenase (COX)-2 selective inhibitors have been shown to have comparable efficacy to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Large outcome studies have shown that patients with OA and RA not taking low-dose aspirin have fewer symptomatic and complicated upper GI events when treated with COX-2 selective inhibitors than with nonselective NSAIDs. When used in recommended dosages, there is no convincing evidence that patients treated with COX-2 selective inhibitors have an increased incidence of cardiovascular thrombotic events, including non-fatal myocardial infarction, than patients treated with either placebo or nonselective NSAIDs other than naproxen. Co-therapy with low-dose aspirin is recommended in patients with OA and RA at increased risk for cardiovascular events; the need for gastroprotective therapy in such patients is controversial.
    Preview · Article · Feb 2003 · Arthritis research & therapy
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    ABSTRACT: The development of cyclooxygenase (COX)-2-selective inhibitors represents a major advance in the management of chronic pain and inflammation that may satisfy an unmet medical need for agents with improved gastrointestinal (GI) safety. This article is a review of the pharmacology, clinical efficacy, and safety of COX-2-selective inhibitors in the managed healthcare setting. The efficacy of COX-2-selective inhibitors in relieving chronic pain from osteoarthritis and rheumatoid arthritis is comparable to that of traditional nonsteroidal anti-inflammatory drugs (NSAIDs). However, the occurrence of GI complications may be less frequent in patients who receive COX-2-selective inhibitors than in patients receiving traditional NSAIDs. Thus, the use of COX-2-selective inhibitors for the management of chronic pain may reduce overall costs and provide an alternative with an improved safety profile compared with traditional NSAIDs.
    Preview · Article · Dec 2002 · The American journal of managed care

  • No preview · Article · Dec 2002 · The Lancet
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