Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Dr Guslandi appropriately points
out that each drug in a class needs to be assessed on a specific basis when
it comes to adjudicating putative lack of safety. For the public and the physician
community, the confusional state on arthritis medications was substantially
exacerbated by the premature discontinuation of the ADAPT trial. Dr Lehmann
notes that some of the patients in this trial were taking concomitant aspirin
on an open-label basis, and that naproxen could theoretically have inhibited
aspirin’s antiplatelet benefit akin to the well-described ibuprofen-aspirin
interaction. It is also noteworthy that the ADAPT trial does not show any
statistically significant excess in myocardial infarction or stroke. I believe
that, until proven otherwise, naproxen should still be considered as the NSAID
agent with the most favorable cardiovascular safety record.
Topol EJ. Arthritis Medications and Cardiovascular Events—Reply. JAMA. 2005;293(16):1975-1977. doi:10.1001/jama.293.16.1976-c