Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis
By S. Trelle, S. Reichenbach, Simon Wandel, Pius Hildebrand, B. Tschannen, P. Villiger, M. Egger, Peter Jüni. British medical journal, 2011
1,146 citations recorded by the source corpus.
Objective To analyse the available evidence on cardiovascular safety of non-steroidal anti-inflammatory drugs. Design Network meta-analysis. Data sources Bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists of relevant articles, and reports citing relevant articles through the Science Citation Index (last update July 2009). Manufacturers of celecoxib and lumiracoxib provided additional data. Study selection All large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug with other non-steroidal anti-inflammatory drugs or placebo. Two investigators independently assessed eligibility. Data extraction The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. Two investigators independently extracted data. Data synthesis 31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death. Conclusions Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.
Subfields: Cardiology and Cardiovascular Medicine, Pharmacology, Surgery
View Paper: https://www.semanticscholar.org/paper/1dc3cfd6e466c5d79e478cd8b2eb0015759f44bb
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Citations in the corpus
- Indirect and mixed‐treatment comparison, network, or multiple‐treatments meta‐analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool (2012, background): “…interpretation of the results; for example, the probability that the relative effectiveness of each treatment reaches a particular threshold of clinical importance has been used to present the results from a network meta-analysis of nonsteroidal anti-inflamatory drugs (Trelle et al., 2011).”
- Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. (2014, positive): “This is in agreement with another previously reported meta-analysis that concluded that although uncertainty remains, a little evidence exists to suggest if any of the investigated drugs are safe in CV terms but apparently naproxen seemed least harmful (162).”
- Anti-Inflammatory Effects of Metformin Irrespective of Diabetes Status (2016, neutral): “22 A better understanding of such glucose-independent properties might foster a more rational, less empirical exploitation of metformin in nondiabetic CVD. Inflammation, including nuclear factor-κ B (NF-κ B) signaling, is increasingly recognized as a significant contributing factor to diabetes melli”
- CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 (2016, background): “Although guidelines also recommend NSAIDs as first-line treatment for osteoarthritis or low back pain (94,98), NSAIDs and COX-2 inhibitors do have risks, including gastrointestinal bleeding or perforation as well as renal and cardiovascular risks (99).”