Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: In their meta-analysis, Dr Mukherjee
and colleagues1 found that cyclooxygenase
2 (COX-2) inhibitors might cause an increase in cardiovascular (CV) events.
This may lead clinicians to avoid COX-2 inhibitors for their patients with
arthritis. I believe that this conclusion is ill advised.
Other nonsteroidal anti-inflammatory drugs (NSAIDs) have been estimated
to have a 1% to 4% annual rate of significant adverse events.2
The 2 large trials of COX-2 inhibitors, VIGOR (Vioxx Gastrointestinal Outcomes
Research Study3) and CLASS (Celecoxib Arthritis
Safety Study4), both found a 1% to 2% decline
in serious gastrointestinal (GI) complications with the use of COX-2 inhibitors
compared with other NSAIDs. In contrast, Mukherjee et al found a 0.24% and
0.3% increase in cardiovascular events for rofecoxib and celecoxib, respectively.
Preventing about 3 CV events per thousand while increasing GI complications
10 to 20 per thousand may not be the most equitable trade.
Burnakis TG. Cardiovascular Events and COX-2 Inhibitors. JAMA. 2001;286(22):2808-2813. doi:10.1001/jama.286.22.2808