Celecoxib safer than ibuprofen, naproxen in arthritic patients
Celecoxib at approved dosages show similar or better cardiovascular, gastrointestinal, and renal safety profiles compared with ibuprofen and naproxen in the management of osteoarthritis (OA) and rheumatoid arthritis (RA), a recent study has reported.
The study assessed the relative safety of chronic use of celecoxib vs ibuprofen and naproxen in 24,081 OA or RA patients at moderate or high cardiovascular risk who participated in the PRECISION study, a double-blind randomized controlled trial. Celecoxib was given at 100–200 mg doses twice daily, ibuprofen at 600–800 mg doses three times daily, and naproxen at 375–500 mg doses twice daily.
Primary outcomes investigated were first occurrence of major adverse cardiovascular events (MACE), gastrointestinal events, renal events, and mortality.
In the OA subgroup, celecoxib-treated patients had significantly reduced risk of MACE compared with those who received ibuprofen (hazard ratio [HR], 0.84; 95 percent CI, 0.72–0.99) but not with patients on naproxen. In the RA subgroup, the HR for MACE among celecoxib-treated patients was 1.06 (0.69–1.63) relative to those on ibuprofen and 1.22 (0.78–1.92) relative to those on naproxen.
Cases of gastrointestinal toxicity were also markedly fewer among celecoxib users vs ibuprofen users (HR, 0.68; 0.51–0.91) and naproxen users (HR, 0.73; 0.55–0.98) in the OA subgroup. A similar trend was observed in the RA subgroup, with HRs of 0.48 (0.22–1.07) and 0.54 (0.24–1.24), respectively.
The risk of renal events was substantially lower among celecoxib users vs ibuprofen users in the OA subgroup (HR, 0.58; 0.40–0.82). Furthermore, celecoxib was associated with significantly lower mortality compared with naproxen in the RA subgroup (HR, 0.47; 0.25–0.88).
“These findings give providers, patients, and regulators a greater understanding of the relative safety of different NSAIDs (nonsteroidal anti-inflammatory drugs), COX2-selective and nonselective,” researchers said, adding that the data confirm no increased CV risk with celecoxib.
“[C]elecoxib conferred slight reductions in risk for several outcomes compared with other commonly used NSAIDs. Regulators and professional organizations might consider whether these data regarding differential safety across NSAIDs warrant new recommendations for the optimal use of the agents studied in PRECISION,” they said.