COX-2 Inhibitors and The Cardiovascular System: A Class Effect?

Conclusions

It seems clear that rofecoxib stands out amongst the COX-2 inhibitors as carrying a greater risk of thrombotic cardiovascular events, oedema and loss of blood pressure control in treated hypertensive patients when compared to classical NSAIDs. The increase in cardiovascular risk is greatest after about 18 months of use, and many of the newer COX-2 inhibitors have not been studied adequately over such prolonged periods. However, the emerging data suggest that the increased cardiovascular risk is probably a class effect, although the absolute risk with drugs other than rofecoxib is small. There may also be a dose-related increase in risk with some drugs, particularly celecoxib and valdecoxib, with the greatest risk at doses higher than those usually used for the treatment of arthritis.

Currently, the Medicines and Healthcare Regulatory Agency (MRHA) recommend avoiding treatment with COX-2 selective inhibitors whenever possible in patients with known ischaemic heart disease or those who are at high risk of developing it. They also recommend that the smallest dose of a COX-2 inhibitor should be prescribed for the shortest possible duration if the drugs are used. The risk associated with the use of meloxicam, a drug with less COX selectivity, has received less attention. Current evidence has not demonstrated any differences from conventional NSAIDs, but definitive studies are awaited.

If the prescription of COX-2 selective inhibitors is considered for patients with ischaemic heart disease, then a full discussion of risk should take place, and all alternative treatment options should be explored. The long-term use of COX-2 inhibitors for patients at lower cardiovascular risk should also be reassessed in the light of the lack of evidence for a reduction in serious gastrointestinal toxicity for many of the drugs compared with classical NSAIDs.  Printer- Friendly Email ThisReprint Address

Correspondence to: Dr DG Waller (email: derek.waller@suht.swest.nhs.uk )

Br J Cardiol.  2005;12(5):387-391.  ©2005 Sherborne Gibbs Ltd.
This is a part of article COX-2 Inhibitors and The Cardiovascular System: A Class Effect? Taken from "Generic Arcoxia (Etoricoxib)" Information Blog