Is Chronic Use of NSAIDs and Cox-2 Inhibitors Safe?

Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is safe in older adults with arthritis and no history of cardiovascular disease, according to a recent study.

Further, standard NSAIDs (like ibuprofen) are just as safe as the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib.
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In order to compare and evaluate the safety of standard NSAIDs against that of Cox-2 inhibitors,  researchers conducted a trial of over 7000 participants (age 60 and older) prescribed non-selective NSAIDs (nsNSAIDs) for osteoarthritis or rheumatoid arthritis. Participants were randomly assigned to either continue nsNSAIDs use or switch to Cox-2 inhibitors, then continue use for an average of 3 years.

Primary and secondary outcomes included hospitalization for non-fatal cardiovascular events, hospitalization for gastrointestinal complications, or death.

Overall, cardiovascular events occurred in 1.8% of those in the Cox-2 inhibitor group and 2.2% in the nsNSAIDs group.

“We found no difference between nsNSAIDs and celecoxib, with low cardiovascular and upper gastrointestinal adverse event rates overall,” researchers wrote.

Serious side effects occurred at similar rates between the groups as well, (5.2% in the Cox-2 inhibitor group and 5.8% in the nsNSAID group), but researchers did find a significant difference in the rate of non-serious adverse events (22% in the Cox-2 inhibito group and 16.1% in the nsNSAID group).

“In our view, it seems unlikely that another trial of nsNSAIDs versus COX-2 inhibitors in subjects free from cardiovascular disease will ever be done due to the low event rates in this population,” they concluded.

—Michael Potts

Reference:

European Society of Cardiology. SCOT study quells concerns about NSAID safety [press release]. August 31, 2015. http://www.alphagalileo.org/ViewItem.aspx?ItemId=155851&CultureCode=en.