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Zyryanov SK, Baybulatova EA. [Current challenges for therapy of comorbid patients: a new look at celecoxib. A review]. TERAPEVT ARKH 2024; 96:531-542. [PMID: 38829816 DOI: 10.26442/00403660.2024.05.202769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
The use of non-steroidal anti-inflammatory drugs (NSAIDs) for a wide range of diseases is increasing, in part due to an increasing elderly population. Elderly patients are more vulnerable to adverse drug reactions, including side effects and adverse effects of drug-drug interactions, often occurring in this category of patients due to multimorbidity and polypharmacy. One of the most popular NSAIDs in the world is celecoxib. It is a selective cyclooxygenase (COX)-2 inhibitor with 375 times more COX-2 inhibitory activity than COX-1. As a result, celecoxib has a better gastrointestinal tract safety profile than non-selective NSAIDs. Gastrointestinal tolerance is an essential factor that physicians should consider when selecting NSAIDs for elderly patients. Celecoxib can be used in a wide range of diseases of the musculoskeletal system and rheumatological diseases, for the treatment of acute pain in women with primary dysmenorrhea, etc. It is also increasingly used as part of a multimodal perioperative analgesia regimen. There is strong evidence that COX-2 is actively involved in the pathogenesis of ischemic brain damage, as well as in the development and progression of neurodegenerative diseases, such as Alzheimer's disease. NSAIDs are first-line therapy in the treatment of acute migraine attacks. Celecoxib is well tolerated in patients with risk factors for NSAID-associated nephropathy. It does not decrease the glomerular filtration rate in elderly patients and patients with chronic renal failure. Many meta-analyses and epidemiological studies have not confirmed the increased risk of cardiovascular events reported in previous clinical studies and have not shown an increased risk of cardiovascular events with celecoxib, irrespective of dose. COX-2 activation is one of the key factors contributing to obesity-related inflammation. Specific inhibition of COX-2 by celecoxib increases insulin sensitivity in overweight or obese patients. Combination therapies may be a promising new area of treatment for obesity and diabetes.
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Affiliation(s)
- S K Zyryanov
- Peoples' Friendship University of Russia named after Patrice Lumumba
| | - E A Baybulatova
- Peoples' Friendship University of Russia named after Patrice Lumumba
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2
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Komatsu R, Singleton MD, Dinges EM, Wu J, Bollag LA. Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients. JA Clin Rep 2024; 10:29. [PMID: 38687413 PMCID: PMC11061052 DOI: 10.1186/s40981-024-00712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/07/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND We investigated in older adult non-cardiac surgical patients whether receipt of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased incidence of postoperative cardiovascular complications. METHODS We retrospectively extracted the information for patients with age ≥ 65 years who had inpatient non-cardiac surgery with a duration of ≥ 1 h from the American College of Surgeons-National Surgical Quality Improvement Program registry data acquired at the University of Washington Medical Center. We compared patients who received NSAIDs perioperatively to those who did not receive NSAIDs, on the two composite outcomes: (1) the incidence of postoperative cardiovascular complications within 30 days of the surgery, and (2) the incidence of combined postoperative gastrointestinal and renal complications, and length of postoperative hospital stay. We used separate multivariable logistic regression models to analyze the two composite outcomes and a Poisson regression model for the length of hospital stay. RESULTS The receipt of perioperative NSAIDs was not associated with postoperative cardiovascular complications (estimated odds ratio (OR), 1.78; 95% confidence interval (CI), 0.97 to 3.25; P = 0.06), combined renal and gastrointestinal complications (estimated OR, 1.30; 95% CI, 0.53 to 3.20; P = 0.57), and length of postoperative hospital stay in days (incidence rate ratio, 1.06; 95% CI, 0.93 to 1.21; P = 0.39). CONCLUSIONS In older adult non-cardiac surgical patients, receipt of perioperative NSAIDs was not associated with increased incidences of postoperative cardiovascular complications, and renal and gastrointestinal complications within 30 days after surgery, or length of postoperative hospital stay.
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Affiliation(s)
- Ryu Komatsu
- Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Michael D Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - Emily M Dinges
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Jiang Wu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Laurent A Bollag
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Monga J, Ghosh NS, Rani I, Singh R, Deswal G, Dhingra AK, Grewal AS. Unlocking the Pharmacological Potential of Benzimidazole Derivatives: A Pathway to Drug Development. Curr Top Med Chem 2024; 24:437-485. [PMID: 38311918 DOI: 10.2174/0115680266283641240109080047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024]
Abstract
Heterocyclic molecules have fascinated a massive interest in medicinal chemistry. They are heterocyclic compounds that have gained significance due to their diverse variety of pharmacological activities. Benzimidazole is a heterocyclic compound consisting of benzene and imidazole rings. The ease of synthesis and the structural versatility of benzimidazole make it a promising scaffold for drug development. Many biological actions of benzimidazole derivatives have been well documented, including antibacterial, antiviral, anticancer, anti-inflammatory, antitubercular, and anthelmintic properties. The mechanism of action of benzimidazole derivatives varies with their chemical structure and target enzyme. This review has explored numerous methods for producing benzimidazole derivatives as well as a broad range of pharmacological activities. SAR investigations are also discussed in this review as they provide crucial details regarding the essential structural qualities that benzimidazole derivatives must have in order to be biologically active, which could aid in the rational design of new drug candidates. Benzimidazole scaffold is an exclusive structure in drug design and discovery. Many new pharmaceutical drugs containing benzimidazole are anticipated to be available within the next ten years as a result of the extensive therapeutic applications of benzimidazole and its derivatives. This review inspired many researchers to develop more biologically active compounds bearing benzimidazole, expanding the scope of finding a remedy for other diseases. From this study, we concluded that 2-substituted benzimidazole was considered more extensively by researchers.
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Affiliation(s)
- Jyoti Monga
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Gangoh, Uttar Pradesh, India
- Ch. Devi Lal College of Pharmacy, Jagadhri, Yamuna Nagar, Haryana, India
| | - Niladry S Ghosh
- Faculty of Pharmaceutical Sciences, Assam down town University, Guwahati, Assam, India
| | - Isha Rani
- Spurthy College of Pharmacy, Marasur Gate, Bengaluru, Karnataka, India
| | - Ranjit Singh
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Gangoh, Uttar Pradesh, India
| | - Geeta Deswal
- Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, India
| | | | - Ajmer S Grewal
- Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, India
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Ailani J, Nahas SJ, Friedman DI, Kunkel T. The Safety of Celecoxib as an Acute Treatment for Migraine: A Narrative Review. Pain Ther 2023; 12:655-669. [PMID: 37093356 PMCID: PMC10199993 DOI: 10.1007/s40122-023-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) have been the first-line choice for the acute treatment of migraine attacks for decades; however, the safety of a particular NSAID is related to its treatment dose, duration, and mechanism of action. Although adverse event (AE) risks differ substantially among individual migraine treatments, increased or prolonged exposure to any NSAID elevates risks and severity of AEs. METHODS For this narrative review, we conducted a literature search of PubMed until July 2022, focusing on the history, mechanism of action, and treatment guidelines informing the safety and efficacy of celecoxib oral solution for the acute treatment of migraine attacks. RESULTS Here we discuss the mechanisms of action of nonselective NSAIDs vs. cyclooxygenase-2 (COX-2) inhibitors, and how these mechanisms underlie the AEs associated with these treatments. We review the clinical trials that influenced the regulatory history of NSAIDs, specifically COX-2 inhibitors, the role of traditional and new formulations of NSAIDs including celecoxib oral solution, and special considerations in the acute treatment of migraine attacks. CONCLUSIONS Low-dose formulations of NSAIDs, such as celecoxib oral solution, provide acute migraine analgesia with similar or fewer associated cardiovascular and gastrointestinal events than previous formulations.
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Affiliation(s)
| | | | | | - Todd Kunkel
- Collegium Pharmaceutical, Inc, 100 Technology Center Drive, Suite 300, Stoughton, MA, 02072, USA.
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Yu L, Luo R, Qin G, Zhang Q, Liang W. Efficacy and safety of anti-interleukin-1 therapeutics in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:100. [PMID: 36782214 PMCID: PMC9923921 DOI: 10.1186/s13018-023-03590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the efficacy and safety of anti-interleukin-1 therapeutics, including IL-1 antibodies, interleukin-1 receptor antagonists (IL-1 Ras) and IL-1 inhibitors, for knee osteoarthritis (KOA) treatment. METHODS Databases (Medline, Embase, Web of Science and CENTRAL) and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) of anti-interleukin-1 therapeutics from inception to August 31, 2022. The outcomes were the mean change in pain and function scores and the risk of adverse effects (AEs). RESULTS In the 12 studies included, anti-interleukin-1 therapeutics were superior to placebo in terms of pain relief (standardized mean difference [SMD] = - 0.38, 95% confidence interval [CI] = - 1.82 to - 0.40, p < 0.001, I2 = 77%) and functional improvement (SMD = - 1.11, 95% CI = - 1.82 to - 0.40, p = 0.002, I2 = 96%). The incidence of any AE (risk ratio [RR] = 1.02, 95% CI = 0.88-1.18, p < 0.001, I2 = 76%) was higher following treatment with anti-interleukin-1 therapeutics than placebo, while no significant difference was found in the incidence of serious AEs (SAEs) or discontinuations due to AEs. Subgroup analyses showed that IL-1 antibodies and the IL-1 inhibitor provided pain relief (IL-1 antibodies: SMD = - 0.61, 95% CI = - 0.92 to - 0.31, p < 0.001; IL-1 inhibitor: SMD = - 0.39, 95% CI = - 0.72 to - 0.06, p = 0.02, I2 = 74.0%) and functional improvement (IL-1 antibodies: SMD = - 1.75, 95% CI = - 2.10 to - 1.40, p < 0.001; IL-1 inhibitor: SMD = - 0.28, 95% CI = - 0.83 to 0.27, p = 0.31, I2 = 88%) superior to those of placebo, whereas IL-1 Ras did not. However, the IL-1 inhibitor increased the incidence of any AE (RR = 1.35, 95% CI = 0.92-1.98, p < 0.001, I2 = 85%) but not the risk of SAEs or discontinuations due to AEs. IL-1 antibodies and IL-1 Ras showed no difference in safety compared with placebo. CONCLUSIONS Anti-interleukin-1 therapeutics could relieve OA-related pain and improve function, but is probably associated with an increased risk of adverse events. Specially, IL-1 antibodies and an IL-1 inhibitor could relieve OA-related pain and improve function, whereas IL-1 Ras could not. IL-1 antibodies and IL-1 Ras were relatively safe options, but IL-1 inhibitors were associated with safety concerns.
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Affiliation(s)
- Lizhi Yu
- grid.440719.f0000 0004 1800 187XThe First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545001 Guangxi Province China
| | - Raoshan Luo
- grid.440719.f0000 0004 1800 187XThe First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545001 Guangxi Province China
| | - Gang Qin
- grid.440719.f0000 0004 1800 187XThe First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545001 Guangxi Province China
| | - Qinyan Zhang
- grid.440719.f0000 0004 1800 187XThe First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545001 Guangxi Province China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, 545001, Guangxi Province, China.
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Calcium complexes of oxicams: new dimensions in rheumatoid arthritis treatment. Future Med Chem 2022; 14:1771-1788. [PMID: 36519430 DOI: 10.4155/fmc-2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Various metals have been complexed with drugs to improve their cellular impact. Inflammatory diseases like rheumatoid arthritis (RA) are characterized by unbalanced production of proinflammatory cytokines (PICs) and prostaglandins with decreased levels of vitamin D and calcium. The inflammation can be suppressed through targeting the formation of PICs or related enzymes by various treatment strategies that involve the use of corticosteroids, disease-modifying antirheumatic drugs and NSAIDs. We present a detailed review on the impact of calcium complexes of oxicams as an advanced treatment strategy for RA. The calcium complexes demonstrate promising capabilities to cure the disease, improve the strength of bones and suppress PICs in RA.
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Low-Dose NSAIDs Efficacy in Orthopedic Applications. Sports Med Arthrosc Rev 2022; 30:147-161. [PMID: 35921597 DOI: 10.1097/jsa.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) [cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitors] and COXIBs (the COX-2 selective inhibitors) may induce several potentially severe and life-threatening issues especially in elderly patients. The use of low-dose NSAIDs is associated with lower risk of side effects compared to the standard dosage. Low-dose NSAIDs could minimize the side effects of these drugs while maintaining their clinical efficacy and effectiveness. The present study evaluates the effectiveness and safety of low-dose NSAIDs in musculoskeletal applications.
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Pishgahi A, Zamani M, Mehdizadeh A, Roshangar L, Afkham-Daghdaghan M, Pourabbas B, Yousefi M. The therapeutic effects of autologous conditioned serum on knee osteoarthritis: an animal model. BMC Res Notes 2022; 15:277. [PMID: 35962413 PMCID: PMC9373483 DOI: 10.1186/s13104-022-06166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
Objective As a progressive chronic condition, osteoarthritis (OA) causes substantial pain and impairment. Secrete proinflammatory cytokines are essential mediators involved in the pathophysiology of OA. In this regard, the clinical effectiveness of autologous conditioned serum (ASC) has been shown through its injection into OA tissues. This study aimed to assess the effectiveness and concentration level of ACS components produced by Nano-carbon glass beads. Intravenous whole blood was obtained from each New Zealand male rabbit by 10-ml syringes, comprising 33 medical-grade Nano carbon-coated glass beads. Serum retrieving was performed after 6–8 h incubation (37 C, 5% Co2), and then centrifuged. The ACS was then injected into OA rabbits to assess its function. Results Glass beads-prepared ACS coated with Nano-carbon, induced a huge amount of cytokines and growth factors production. The concentration level of anti-inflammatory cytokines and proinflammatory cytokines was improved throughout Nano-carbon coated glass beads stimulation. ACS also shortened the recovery time and improved the function and mobility of OA rabbits. We showed that ACS improved the function and mobility of OA rabbits, as well as shortened the recovery time. It is suggested that further studies evaluate this effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06166-1.
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Affiliation(s)
- Alireza Pishgahi
- Stem Cell Research Center, Tabriz University of Medical Sciences, PO Box: 6446-14155, Tabriz, Iran
| | - Majid Zamani
- Department of Medical Laboratory Sciences, Faculty of Allied Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Amir Mehdizadeh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Roshangar
- Stem Cell Research Center, Tabriz University of Medical Sciences, PO Box: 6446-14155, Tabriz, Iran
| | - Milad Afkham-Daghdaghan
- Stem Cell Research Center, Tabriz University of Medical Sciences, PO Box: 6446-14155, Tabriz, Iran
| | - Behzad Pourabbas
- Stem Cell Research Center, Tabriz University of Medical Sciences, PO Box: 6446-14155, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, PO Box: 6446-14155, Tabriz, Iran.
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Cheng BR, Chen JQ, Zhang XW, Gao QY, Li WH, Yan LJ, Zhang YQ, Wu CJ, Xing JL, Liu JP. Cardiovascular safety of celecoxib in rheumatoid arthritis and osteoarthritis patients: A systematic review and meta-analysis. PLoS One 2021; 16:e0261239. [PMID: 34932581 PMCID: PMC8691614 DOI: 10.1371/journal.pone.0261239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the cardiovascular safety of celecoxib compared to non-selective non-steroid anti-inflammatory drugs or placebo. METHODS We included randomized controlled trials of oral celecoxib compared with a non-selective NSAID or placebo in rheumatoid arthritis and osteoarthritis patients. We conducted searches in EMBASE, Cochrane CENTRAL, MEDLINE, China National Knowledge Infrastructure, VIP, Wanfang, and Chinese Biomedical Literature Database. Study selection and data extraction were done by two authors independently. The risk of bias was assessed using Cochrane's risk-of-bias Tool for Randomized Trials. The effect size was presented as a risk ratio with their 95% confidence interval. RESULTS Until July 22nd, 2021, our search identified 6279 records from which, after exclusions, 21 trials were included in the meta-analysis. The overall pooled risk ratio for Antiplatelet Trialists Collaboration cardiovascular events for celecoxib compared with any non-selective non-steroid anti-inflammatory drugs was 0.89 (95% confidence interval: 0.80-1.00). The pooled risk ratio for all-cause mortality for celecoxib compared with non-selective non-steroid anti-inflammatory drugs was 0.81 (95% confidence interval: 0.66-0.98). The cardiovascular mortality rate of celecoxib was lower than non-selective non-steroid anti-inflammatory drugs (risk ratio: 0.75, 95% confidence interval: 0.57-0.99). There was no significant difference between celecoxib and non-selective non-steroid anti-inflammatory drugs or placebo in the risk of other cardiovascular events. CONCLUSION Celecoxib is relatively safe in rheumatoid arthritis and osteoarthritis patients, independent of dose or duration. But it remains uncertain whether this would remain the same in patients treated with aspirin and patients with established cardiovascular diseases.
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Affiliation(s)
- Bai-Ru Cheng
- The First School of Clinical Medicine (Dongzhimen Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Qi Chen
- Clinical College (China-Japan Friendship Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Wen Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qin-Yang Gao
- The First School of Clinical Medicine (Dongzhimen Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Wei-Hong Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Jiao Yan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Qiao Zhang
- Clinical College (China-Japan Friendship Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Chang-Jiang Wu
- The Second School of Clinical Medicine (Dongfang Hospital), Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Li Xing
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Sathishkumar P, Mohan K, Meena RAA, Balasubramanian M, Chitra L, Ganesan AR, Palvannan T, Brar SK, Gu FL. Hazardous impact of diclofenac on mammalian system: Mitigation strategy through green remediation approach. JOURNAL OF HAZARDOUS MATERIALS 2021; 419:126135. [PMID: 34157463 DOI: 10.1016/j.jhazmat.2021.126135] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/24/2021] [Accepted: 05/12/2021] [Indexed: 05/22/2023]
Abstract
Diclofenac is an anti-inflammatory drug used as an analgesic. It is often detected in various environmental sources around the world and is considered as one of the emerging contaminants (ECs). This paper reviews the distribution of diclofenac at high concentrations in diverse environments and its adverse ecological impact. Recent studies observed strong evidence of the hazardous effect of diclofenac on mammals, including humans. Diclofenac could cause gastrointestinal complications, neurotoxicity, cardiotoxicity, hepatotoxicity, nephrotoxicity, hematotoxicity, genotoxicity, teratogenicity, bone fractures, and skin allergy in mammals even at a low concentration. Collectively, this comprehensive review relates the mode of toxicity, level of exposure, and route of administration as a unique approach for addressing the destructive consequence of diclofenac in mammalian systems. Finally, the mitigation strategy to eradicate the diclofenac toxicity through green remediation is critically discussed. This review will undoubtedly shed light on the toxic effects of pseudo-persistent diclofenac on mammals as well as frame stringent guidelines against its common usage.
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Affiliation(s)
- Palanivel Sathishkumar
- Key Laboratory of Theoretical Chemistry of Environment, Ministry of Education; School of Chemistry, South China Normal University, Guangzhou 510006, PR China
| | - Kannan Mohan
- PG and Research Department of Zoology, Sri Vasavi College, Erode, Tamil Nadu 638 316, India
| | | | - Murugesan Balasubramanian
- Department of Biotechnology, K.S. Rangasamy College of Technology, Tiruchengode 637 215, Tamil Nadu, India
| | - Loganathan Chitra
- Department of Biochemistry, Periyar University, Salem 636 011, Tamil Nadu, India
| | - Abirami Ramu Ganesan
- Group of Fermentation and Distillation, Laimburg Research Center, Vadena (BZ), Italy
| | | | - Satinder Kaur Brar
- Department of Civil Engineering, Lassonde School of Engineering, York University, North York, Toronto, Ontario M3J 1P3, Canada
| | - Feng Long Gu
- Key Laboratory of Theoretical Chemistry of Environment, Ministry of Education; School of Chemistry, South China Normal University, Guangzhou 510006, PR China.
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Yang JH, Lee BH, Eum KS, Suk KS, Park JO, Kim HS, Lee HM, Moon SH. Prevalence of Gastrointestinal and Cardiovascular Risk in Patients with Degenerative Lumbar Spinal Disease. Clin Orthop Surg 2020; 12:343-352. [PMID: 32904035 PMCID: PMC7449855 DOI: 10.4055/cios20021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Limited information is available about the proportion of patients with degenerative lumbar spinal disease (DLSD) who have gastrointestinal (GI) and cardiovascular (CV) risk factors. Many DLSD patients are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) that are known to carry risks to the GI and CV systems by increasing GI bleeding and thromboembolic events. This study aimed to measure the prevalence of GI and CV risk in patients with DLSD and to ascertain whether the prescription of NSAIDs is in line with current guidelines. Methods This study included 153 patients with symptomatic DLSD who were planning to undergo lumbar spinal surgery. The GI profile was checked using the GI Standardized Calculator of Risk for Event system and CV risk was evaluated using the presence of metabolic syndrome. The conformity of the prescription of NSAIDs was investigated according to the recommendations in current guidelines. Results More than half of the patients (59.5%) had high or very high GI risk, and 66% of the patients were diagnosed with metabolic syndrome, which corresponds with CV risk. The rate of simultaneous GI and CV risk was 40.5% (n = 62 / 153; gastrointestinal Standardized Calculator of Risk for Event, > high and metabolic syndrome, yes). The actual prescription of NSAIDs was not in accordance with current guidelines. Conclusions Two out of 3 patients had GI or CV risk factors, and approximately 40% of patients had both. Detailed assessment of GI and CV risk in patients with DLSD by using effective evaluation tools is mandatory for optimal medical treatment.
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Affiliation(s)
- Jae-Ho Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung-Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Sik Eum
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung-Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Oh Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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13
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Jo HA, Kim DK, Park S, Kim Y, Han SS, Yang BR, Choi SH, Kim MS, Lee J, Lee H, Lee JP, Lim CS, Kim YS, Joo KW. Cardiovascular risk of nonsteroidal anti-inflammatory drugs in dialysis patients: a nationwide population-based study. Nephrol Dial Transplant 2020; 36:909-917. [DOI: 10.1093/ndt/gfz276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Given the cardiovascular risk of nonsteroidal anti-inflammatory drugs (NSAIDs), it is essential to identify the relationship between NSAIDs and cardiovascular outcomes in dialysis patients who have elevated cardiovascular risk.
Methods
A case-crossover study was conducted to assess the association of NSAIDs with major adverse cardiac and cerebrovascular events (MACCEs) and mortality using the Korean Health Insurance dataset. The case period was defined as 1–30 days prior to the event date and the control periods were defined as 61–90 days and 91–120 days prior to the event date.
Results
There were 3433 and 8524 incident dialysis patients who experienced MACCEs and mortality, respectively, after exposure to NSAIDs within 120 days before each event. NSAIDs significantly increased the risk of MACCEs {adjusted odds ratio [aOR] 1.37 [95% confidence interval (CI) 1.26–1.50]} and mortality [aOR 1.29 (95% CI 1.22–1.36)]. Nonselective NSAIDs, but not selective cyclooxygenase-2 inhibitors, significantly increased the risk of MACCEs and mortality. However, the MACCE and mortality risk did not increase in a dose-dependent manner in the analysis according to the cumulative defined daily dosage of NSAIDs. The incidence of MACCEs in the case period tended to be more common in patients who had recent exposure to NSAIDs than in patients who did not have recent exposure to NSAIDs.
Conclusions
Clinicians should be particularly cautious when prescribing NSAIDs to dialysis patients considering the associations of NSAIDs with cardiovascular outcomes and mortality, which might occur independent of the dose and duration of exposure.
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Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bo Ram Yang
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - So-Hyun Choi
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Mi-Sook Kim
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, Incheon, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Synthesis, biological evaluation and molecular modeling of novel selective COX-2 inhibitors: sulfide, sulfoxide, and sulfone derivatives of 1,5-diarylpyrrol-3-substituted scaffold. Bioorg Med Chem 2019; 27:115045. [DOI: 10.1016/j.bmc.2019.115045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022]
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Abstract
Introduction: The cyclooxygenase (COX)-2 inhibitor celecoxib is an approved compound for rheumatoid (RA) and osteoarthritis (OA), combining both anti-inflammatory and analgesic properties with a good gastrointestinal tolerability. Areas covered: This article covers the pharmacological properties and clinical efficacy as well as the latest safety data available for celecoxib with emphasis on the treatment of RA and OA. It is based primarily on a current literature search on PubMed and Web of Science, but also on the professional rheumatological expertise of the authors. Expert opinion: Celecoxib has been shown to be superior to placebo and equivalent to traditional non-steroidal anti-inflammatory drugs (tNSAIDs). Many studies have been published making celecoxib a good and safe treatment option in particular in moderate arthritis and patients without established cardiovascular (CV) disease. Moreover, older patients might gain significant benefits compared to tNSAIDs due to reduced gastrointestinal events even when having a history of ulcer bleedings. Nonetheless, there is still much to learn, especially regarding the prescription of celecoxib in patients with cardiovascular co-morbidities. While low doses seem to be safe according to present data, the knowledge on the more effective, higher doses >400 mg/day is still limited.
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Affiliation(s)
- Marco Krasselt
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre , Leipzig , Germany
| | - Christoph Baerwald
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre , Leipzig , Germany
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Akazawa M, Mimura W, Togo K, Ebata N, Harada N, Murano H, Abraham L, Fujii K. Patterns of drug treatment in patients with osteoarthritis and chronic low back pain in Japan: a retrospective database study. J Pain Res 2019; 12:1631-1648. [PMID: 31190973 PMCID: PMC6535438 DOI: 10.2147/jpr.s203553] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/16/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose: Musculoskeletal diseases, including osteoarthritis (OA) and low back pain (LBP), are the leading causes of years lived with disability, and are associated with lowered quality-of-life, lost productivity, and increased healthcare costs. However, information publicly available regarding the Japanese real-world usage of prescription medications is limited. This study aimed to describe the clinical characteristics of patients with OA and chronic LBP (CLBP), and to investigate the patterns of medications and opioid use in Japanese real-world settings. Materials and methods: A retrospective study was conducted using a Japanese administrative claims database between 2013 and 2017. The outcomes were patient characteristics and prescription medications, and they were evaluated separately for OA and CLBP. Results: The mean age of 118,996 patients with OA and 256,402 patients with CLBP was 68.8±13.1 years and 64.8±16.4 years, respectively. Approximately 90% of patients with OA and CLBP were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Other prescriptions included hyaluronate injection (35.6%), acetaminophen (21.4%), and steroid injection (20.0%) in patients with OA, and pregabalin (39.0%) and acetaminophen (22.4%) in patients with CLBP. Weak opioids were prescribed to 10.7% and 20.6% of patients with OA and CLBP, respectively. The prescription of COX-2 inhibitors (OA: +6.5%; CLBP: +6.7%) and acetaminophen (OA: +16.4%; CLBP: +14.4%) increased between 2013 and 2017. The first commonly prescribed medication among patients with OA and CLBP were NSAIDs; hyaluronate injection (patients with OA) and pregabalin (patients with CLBP) were also common first-line medications. Acetaminophen, steroid injection (patients with OA), and weak opioids were prescribed more in the later phases of treatment. Conclusion: Most patients were prescribed limited classes of pain drugs, with NSAIDs being the most common pain medication in Japan for patients with OA and CLBP. Opioid prescription was uncommon, and were weak opioids when prescribed.
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Affiliation(s)
- Manabu Akazawa
- Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Wataru Mimura
- Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Kanae Togo
- Corporate Affairs, Health & Value, Pfizer Japan Inc., Tokyo, Japan
| | - Nozomi Ebata
- Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Noriko Harada
- Clinical Research, Pfizer R&D Japan G.K., Tokyo, Japan
| | - Haruka Murano
- Clinical Research Professionals, Clinical Study Support Inc., Nagoya, Japan
| | - Lucy Abraham
- Patient & Health Impact, Pfizer Ltd., Surrey, UK
| | - Koichi Fujii
- Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
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Copsey B, Buchanan J, Fitzpatrick R, Lamb SE, Dutton SJ, Cook JA. Duration of Treatment Effect Should Be Considered in the Design and Interpretation of Clinical Trials: Results of a Discrete Choice Experiment. Med Decis Making 2019; 39:461-473. [DOI: 10.1177/0272989x19841877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. This study examined whether duration of treatment effect should be considered in a benefit-risk assessment using a case study of osteoarthritis medications. Study Design and Setting. A discrete choice experiment was completed by 300 residents of the United Kingdom with hip and/or knee osteoarthritis. In 16 choice tasks, participants selected their preferred option from 2 medications. Medications were described in terms of effect on pain, stiffness, and function; duration of treatment effect; and risk of heart attack and stomach ulcer bleeding. The analysis used mixed-effects logistic regression. Results. Pain, disease severity, and duration of treatment effect had the greatest influence on medication preferences, whereas stiffness did not significantly affect medication choice. Participants were willing to accept an increase in the risk of heart attack of 2.6% (95% confidence interval: 2.0% to 3.2%) to increase the duration of treatment effect from 1 month to 12 months. Reducing pain from moderate to mild was valued the same as increasing duration of effect from 1 month to 3 months; both were seen as equivalent to an absolute reduction of 1.2% in the risk of heart attack in the next year. Subgroup analysis suggested disease severity influenced patient preferences. Conclusions. Along with treatment benefits and risks, the results suggest that duration of treatment effect is an important factor in the medication choices of people with osteoarthritis. This could have implications for the design and interpretation of clinical trials, for example, incorporating longer-term surveillance of trial participants and accounting for duration of treatment effect in risk-benefit assessments. Future research is needed to assess whether these findings are generalizable to other samples, disease areas, and levels of duration of effect.
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Affiliation(s)
- Bethan Copsey
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - James Buchanan
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Raymond Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Sarah E. Lamb
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - Susan J. Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
| | - Jonathan A. Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, UK
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Cooper C, Chapurlat R, Al-Daghri N, Herrero-Beaumont G, Bruyère O, Rannou F, Roth R, Uebelhart D, Reginster JY. Safety of Oral Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: What Does the Literature Say? Drugs Aging 2019; 36:15-24. [PMID: 31073921 PMCID: PMC6509083 DOI: 10.1007/s40266-019-00660-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.
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Affiliation(s)
- Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Roland Chapurlat
- INSERM, UMR 1033, Université de Lyon, Hôpital E Herriot, Lyon, France
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Gabriel Herrero-Beaumont
- Rheumatology Service, Joint and Bone Research Unit, Autonomous University of Madrid, Fundación Jiménez Díaz, Madrid, Spain
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - François Rannou
- Division of Physical Medicine and Rehabilitation, Department of Rheumatology, AP-HP Cochin Hospital, INSERM U1124, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Roland Roth
- Max-Reger-Strasse 17-19, Essen-Suedviertel, Germany
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais, Centre Hospitalier du Valais Romand, CVP, Crans-Montana, Switzerland
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Gurbel P, Tantry U, Weisman S. A narrative review of the cardiovascular risks associated with concomitant aspirin and NSAID use. J Thromb Thrombolysis 2018; 47:16-30. [DOI: 10.1007/s11239-018-1764-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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20
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Abstract
Supplemental Digital Content is available in the text. Cohort studies can be biased by unmeasured confounding. We propose a hybrid ecologic-epidemiologic design called the trend-in-trend design, which requires a strong time trend in exposure, but is unbiased unless there are unmeasured factors affecting outcome for which there are time trends in prevalence that are correlated with time trends in exposure across strata with different exposure trends. Thus, the conditions under which the trend-in-trend study is biased are a subset of those under which a cohort study is biased. The trend-in-trend design first divides the study population into strata based on the cumulative probability of exposure given covariates, which effectively stratifies on time trend in exposure, provided there is a trend. Next, a covariates-free maximum likelihood model estimates the odds ratio (OR) using data on exposure prevalence and outcome frequency within cumulative probability of exposure strata, across multiple periods. In simulations, the trend-in-trend design produced ORs with negligible bias in the presence of unmeasured confounding. In empiric applications, trend-in-trend reproduced the known positive association between rofecoxib and myocardial infarction (observed OR: 1.2, 95% confidence interval: 1.1, 1.4), and known null associations between rofecoxib and severe hypoglycemia (OR = 1.1 [0.92, 1.3]) and nonvertebral fracture (OR = 0.84 [0.64, 1.1]). The trend-in-trend method may be useful in settings where there is a strong time trend in exposure, such as a newly approved drug or other medical intervention. See video abstract at, http://links.lww.com/EDE/B178.
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Stehlik P, Rosella L, Henry D. Commentary: Renewed controversy over cardiovascular risk with non-steroidal anti-inflammatory drugs. Int J Epidemiol 2018; 47:362-367. [PMID: 29390133 DOI: 10.1093/ije/dyx284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Paulina Stehlik
- Centre for Research in Evidence Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Laura Rosella
- Dalla Lana School of Health, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - David Henry
- Centre for Research in Evidence Based Practice, Bond University, Gold Coast, QLD, Australia.,Dalla Lana School of Health, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON Canada
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22
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Fokunang C. Overview of non-steroidal anti-inflammatory drugs (nsaids) in resource limited countries. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/mojt.2018.04.00081] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Prada-Ramallal G, Takkouche B, Figueiras A. Diverging Conclusions from the Same Meta-Analysis in Drug Safety: Source of Data (Primary Versus Secondary) Takes a Toll. Drug Saf 2017; 40:351-358. [PMID: 28005253 DOI: 10.1007/s40264-016-0492-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Meta-analyses of observational studies represent an important tool for assessing efficacy and safety in the pharmacoepidemiologic field. The data from the individual studies are either primary (i.e., collected through interviews or self-administered questionnaires) or secondary (i.e., collected from databases that were established for other purposes). So far, the origin of the data (primary vs. secondary) has not been systematically assessed as a source of heterogeneity in pharmacoepidemiologic meta-analyses. OBJECTIVE The aim was to assess the impact of considering the source of exposure data as a criterion in sensitivity and subgroup analysis on the conclusions of drug safety meta-analyses. METHODS We selected meta-analyses published between 2013 and 2015 in which the intake of frequently used over-the-counter medicines was either the main exposure or a concomitant treatment and the outcome had short latency and induction periods. We stratified the results by origin of data (primary vs. secondary) and compared the new results to those presented originally in the meta-analyses. RESULTS We used four meta-analyses that fulfilled our criteria of inclusion. The results were selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: original estimate odds ratio (OR) = 1.71 [95% confidence interval (CI) 1.44-2.04], OR primary data = 1.19 (95% CI 0.90-1.58), OR secondary data = 1.81 (95% CI 1.50-2.17); proton pump inhibitors and cardiac events: original estimate hazard ratio (HR) = 1.35 (95% CI 1.18-1.54), HR primary data = 1.05 (95% CI 0.87-1.26), HR secondary data = 1.43 (95% CI 1.23-1.66); non-aspirin non-steroidal anti-inflammatory drugs and myocardial infarction: original estimate risk ratio (RR) = 1.08 (95% CI 0.95-1.22), RR primary data = 0.57 (95% CI 0.34-0.96), RR secondary data = 1.15 (95% CI 1.03-1.28); paracetamol during pregnancy and childhood asthma: original estimate OR = 1.32 (95% CI 1.14-1.52), OR primary data = 1.23 (95% CI 1.06-1.42), OR secondary data = 1.53 (95% CI 1.33-1.75). CONCLUSIONS The results after stratification are considerably modified. It is crucial to explore the origin of the data, either primary or secondary, as a source of heterogeneity in pharmacoepidemiologic meta-analyses to avoid misleading conclusions.
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Affiliation(s)
- Guillermo Prada-Ramallal
- Department of Preventive Medicine and Public Health, Facultad de Medicina, University of Santiago de Compostela, c/San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine and Public Health, Facultad de Medicina, University of Santiago de Compostela, c/San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Facultad de Medicina, University of Santiago de Compostela, c/San Francisco s/n, 15786, Santiago de Compostela, A Coruña, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain.
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Thöne K, Kollhorst B, Schink T. Non-Steroidal Anti-Inflammatory Drug Use and the Risk of Acute Myocardial Infarction in the General German Population: A Nested Case-Control Study. Drugs Real World Outcomes 2017; 4:127-137. [PMID: 28676983 PMCID: PMC5567458 DOI: 10.1007/s40801-017-0113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased relative risk of acute myocardial infarction (AMI), but the label warnings refer particularly to patients with cardiovascular risk factors. The magnitude of relative AMI risk for patients with and without cardiovascular risk factors varies between studies depending on the drugs and doses studied. Objectives The aim of our study was to estimate population-based relative AMI risks for individual and widely used NSAIDs, for a cumulative amount of NSAID use, and for patients with and without a prior history of cardiovascular risk factors. Methods Based on data from the German Pharmacoepidemiological Research Database (GePaRD) of about 17 million insurance members from four statutory health insurance providers, for the years 2004–2009, a nested case–control study was conducted within a cohort of 3,476,931 new NSAID users classified into current, recent, or past users. Up to 100 controls were matched to each case by age, sex, and length of follow-up using risk set sampling. Multivariable conditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Duration of NSAID use was calculated by the cumulative amount of dispensed defined daily doses (DDDs), and stratified analyses were conducted for potential effect modifiers. Results Overall, 17,236 AMI cases were matched to 1,714,006 controls. Elevated relative AMI risks were seen for current users of fixed combinations of diclofenac with misoprostol (OR 1.76, 95% CI 1.26–2.45), indometacin (1.69, 1.22–2.35), ibuprofen (1.54, 1.43–1.65), etoricoxib (1.52, 1.24–1.87), and diclofenac (1.43, 1.34–1.52) compared with past use. A low cumulative NSAID amount was associated with a higher relative AMI risk for ibuprofen, diclofenac, and indometacin. The relative risk associated with current use of diclofenac, fixed combinations of diclofenac with misoprostol, etoricoxib, and ibuprofen was highest in the younger age group (<60 years) and similar for patients with or without major cardiovascular risk factors. Conclusion Relative AMI risk estimates differed among the 15 investigated individual NSAIDs. Diclofenac and ibuprofen, the most frequently used NSAIDs, were associated with a 40–50% increased relative risk of AMI, even for low cumulative NSAID amounts. The relative AMI risk in patients with and without cardiovascular risk factors was similarly elevated. Electronic supplementary material The online version of this article (doi:10.1007/s40801-017-0113-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathrin Thöne
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bianca Kollhorst
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
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25
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Bouquet É, Urbanski G, Lavigne C, Lainé-Cessac P. Unexpected drug-induced Raynaud phenomenon: Analysis from the French national pharmacovigilance database. Therapie 2017; 72:547-554. [PMID: 28336160 DOI: 10.1016/j.therap.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the association between exposure to medicinal products and Raynaud phenomenon. METHODS The study used the data of all adverse drug reactions notified to the French national pharmacovigilance database. All cases reported between 1st January 1995 and 10th December 2012 were selected. A case/non-case method was used to measure disproportionality of the association between drug exposure and Raynaud phenomenon. The cases concerned all observations involving Raynaud phenomenon. Non-cases comprised all other reports of adverse drug reactions over the same period. RESULTS/DISCUSSION Among the 307,128 adverse drug reaction reports selected from the French national pharmacovigilance database, 175 involved Raynaud phenomenon, most of them affecting women (61.1%). The mean age was 50.1 years, and 8% had a past medical history of Raynaud phenomenon. According to the summaries of product characteristics, 42.3% of these cases were exposed to drugs known to induce Raynaud phenomenon. Unexpected Raynaud phenomenons (unlisted in the summaries of product characteristics) were associated with exposure to drugs for which Raynaud phenomenons are published (interferons, ribavirin, gemcitabine) or for which Raynaud phenomenons are not published (hepatitis B vaccine, isotretinoin, leflunomide, hydroxycarbamide, rofecoxib, telmisartan, zolmitriptan). CONCLUSION The case/non-case method is usually used to generate signals. Further epidemiological studies are now necessary to confirm these findings.
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Affiliation(s)
- Émilie Bouquet
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France.
| | - Geoffrey Urbanski
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Christian Lavigne
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Pascale Lainé-Cessac
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France
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Marsico F, Paolillo S, Filardi PP. NSAIDs and cardiovascular risk. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1: Special Issue on The State of the Art for the Practicing Cardiologist: The 2016 Conoscere E Curare Il Cuore (CCC) Proceedings from the CLI Foundation:e40-e43. [DOI: 10.2459/jcm.0000000000000443] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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27
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Zingler G, Hermann B, Fischer T, Herdegen T. Cardiovascular adverse events by non-steroidal anti-inflammatory drugs: when the benefits outweigh the risks. Expert Rev Clin Pharmacol 2016; 9:1479-1492. [DOI: 10.1080/17512433.2016.1230495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Gerhard Zingler
- Medical Department, Former employee of MSD Sharp & Dohme GmbH, Munich, Germany
| | - Birgit Hermann
- Practical Orthopedist (Private Practice), Hamburg, Germany
| | - Tim Fischer
- Medical Department, Employee of MSD Sharp & Dohme GmbH, Munich, Germnany
| | - Thomas Herdegen
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
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Aminoshariae A, Kulild JC, Donaldson M. Short-term use of nonsteroidal anti-inflammatory drugs and adverse effects: An updated systematic review. J Am Dent Assoc 2015; 147:98-110. [PMID: 26562732 DOI: 10.1016/j.adaj.2015.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND In this article, the authors examine the available scientific evidence regarding adverse effects of short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Short-term use was defined as 10 days or fewer. METHODS The authors reviewed randomized controlled clinical trials and cohort and case-controlled clinical studies published between 2001 and June 2015 in which the investigators reported on the safety of nonselective cyclooxygenase inhibitors and of cyclooxygenase-2 selective inhibitor NSAIDs. RESULTS The systematic review process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines allowed the authors to identify 40 studies that met the inclusion criteria. CONCLUSIONS On the basis of the available scientific evidence, NSAIDs may be considered relatively safe drugs when prescribed at the most effective dose and for the shortest duration of time, which was defined to be 10 days or fewer. PRACTICAL IMPLICATIONS Although the US Food and Drug Administration recommends the use of NSAIDs beyond 10 days to be accompanied by a consultation with a health care provider, the use of NSAIDs may be considered relatively safe when prescribed at the most effective dose and for the shortest duration of time, which was defined as 10 days or fewer. Exceptions would be for patients at risk of developing NSAID-exacerbated respiratory disease, patients with prior myocardial infarction who are receiving antithrombotic therapy, patients with asthma, and patients with a history of renal disease.
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Schjerning Olsen AM, Lindhardsen J, Gislason GH, McGettigan P, Hlatky MA, Fosbøl E, Køber L, Torp-Pedersen C, Lamberts M. Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics: nationwide study. BMJ 2015; 351:h5096. [PMID: 26481405 PMCID: PMC4609736 DOI: 10.1136/bmj.h5096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY QUESTION What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? METHODS This was a nationwide cohort study based on linked administrative registry data from all hospitals in Denmark between 1997 and 2011. The study included patients aged 30 years and over admitted with a first myocardial infarction who survived at least 30 days after discharge. The association between PPIs and risk of gastrointestinal bleeding according to NSAID plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. STUDY ANSWER AND LIMITATIONS The use of PPIs was independently associated with decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with NSAIDs. Of 82,955 post-myocardial infarction patients (mean age 67.4 years, 64% (n=53,070) men), all of whom were taking single or dual antithrombotic therapy, 42.5% (n=35,233) filled at least one prescription for NSAIDs and 45.5% (n=37,771) received PPIs. Over a mean follow-up of 5.1 years, 3229 gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0.95) regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. The main limitation of the study is its observational non-randomised design. The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot be avoided in post-myocardial infarction patients, physicians might prescribe a PPI as well. The study does not clarify whether PPIs might be safely omitted in specific subgroups of patients with a low risk of gastrointestinal bleeding. WHAT THIS STUDY ADDS In post-myocardial infarction patients, bleeding complications have been associated with both antithrombotic and NSAID treatment. Concurrent use of PPIs was independently associated with a decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and NSAID, regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. FUNDING, COMPETING INTERESTS, DATA SHARING AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation.
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Affiliation(s)
- Anne-Marie Schjerning Olsen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark William Harvey Research Institute (WHRI) at Barts and the London School of Medicine and Dentistry, London, UK
| | - Jesper Lindhardsen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark Danish Heart Foundation, Copenhagen, Denmark National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute (WHRI) at Barts and the London School of Medicine and Dentistry, London, UK
| | - Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA, USA
| | - Emil Fosbøl
- Department of Cardiology, Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Lu N, Misra D, Neogi T, Choi HK, Zhang Y. Total joint arthroplasty and the risk of myocardial infarction: a general population, propensity score-matched cohort study. Arthritis Rheumatol 2015; 67:2771-9. [PMID: 26331443 PMCID: PMC4581914 DOI: 10.1002/art.39246] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/15/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To replicate recent findings indicating that total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgery will substantially reduce the risk of serious cardiovascular events among patients with osteoarthritis. METHODS A time-stratified, propensity score-matched cohort study was conducted to assess the incidence of myocardial infarction (MI) in a UK general population. The study population included individuals ages ≥50 years who had a UK National Health Service READ code diagnosis of knee osteoarthritis (to evaluate TKA) or hip osteoarthritis (to evaluate THA) between January 2000 and December 2012. RESULTS Among the patients who underwent TKA and their matched non-TKA control subjects (each n = 13,849), 306 patients and 286 control subjects developed MI during the followup. During the first postoperative month, the risk of MI was substantially increased among the TKA group compared with the non-TKA group (hazard ratio [HR] 8.75, 95% confidence interval [95% CI] 3.11-24.62), and then gradually declined during the subsequent followup. The HR for the risk of MI over the entire followup was 0.98 (95% CI 0.82-1.18). The corresponding HRs for the risk of MI in those who had undergone THA compared with the non-THA group (each n = 6,063) were 4.33 (95% CI 1.24-15.21) in the first postoperative month and 0.87 (95% CI 0.66-1.15) overall. In analyses using venous thromboembolism as a positive control outcome, both the first month and overall HRs for the risk of venous thromboembolism were substantially increased in both the TKA and THA groups. CONCLUSION These findings provide the first general population-based evidence to indicate that TKA and THA among osteoarthritis patients are associated with a substantially increased risk of MI during the immediate postoperative period. However, the overall long-term impact of these surgeries was null, unlike the risk of venous thromboembolism, which remained elevated years after patients had undergone the procedure.
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Affiliation(s)
- Na Lu
- Boston University School of Medicine, Clinical Epidemiology Unit/Rheumatology, 650 Albany Street, Suite X-200 Boston, MA, USA 02118
- Massachusetts General Hospital, Harvard Medical School, Division of Rheumatology, Allergy and Immunology, 55 Fruit Street – Bulfinch 165 Boston, MA, USA 02114
| | - Devyani Misra
- Boston University School of Medicine, Clinical Epidemiology Unit/Rheumatology, 650 Albany Street, Suite X-200 Boston, MA, USA 02118
| | - Tuhina Neogi
- Boston University School of Medicine, Clinical Epidemiology Unit/Rheumatology, 650 Albany Street, Suite X-200 Boston, MA, USA 02118
| | - Hyon K. Choi
- Boston University School of Medicine, Clinical Epidemiology Unit/Rheumatology, 650 Albany Street, Suite X-200 Boston, MA, USA 02118
- Massachusetts General Hospital, Harvard Medical School, Division of Rheumatology, Allergy and Immunology, 55 Fruit Street – Bulfinch 165 Boston, MA, USA 02114
| | - Yuqing Zhang
- Boston University School of Medicine, Clinical Epidemiology Unit/Rheumatology, 650 Albany Street, Suite X-200 Boston, MA, USA 02118
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Serghiou S, Patel CJ, Tan YY, Koay P, Ioannidis JPA. Field-wide meta-analyses of observational associations can map selective availability of risk factors and the impact of model specifications. J Clin Epidemiol 2015; 71:58-67. [PMID: 26415577 DOI: 10.1016/j.jclinepi.2015.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Instead of evaluating one risk factor at a time, we illustrate the utility of "field-wide meta-analyses" in considering all available data on all putative risk factors of a disease simultaneously. STUDY DESIGN AND SETTING We identified studies on putative risk factors of pterygium (surfer's eye) in PubMed, EMBASE, and Web of Science. We mapped which factors were considered, reported, and adjusted for in each study. For each putative risk factor, four meta-analyses were done using univariate only, multivariate only, preferentially univariate, or preferentially multivariate estimates. RESULTS A total of 2052 records were screened to identify 60 eligible studies reporting on 65 putative risk factors. Only 4 of 60 studies reported both multivariate and univariate regression analyses. None of the 32 studies using multivariate analysis adjusted for the same set of risk factors. Effect sizes from different types of regression analyses led to significantly different summary effect sizes (P-value < 0.001). Observed heterogeneity was very high for both multivariate (median I(2), 76.1%) and univariate (median I(2), 85.8%) estimates. No single study investigated all 11 risk factors that were statistically significant in at least one of our meta-analyses. CONCLUSION Field-wide meta-analyses can map availability of risk factors and trends in modeling, adjustments and reporting, as well as the impact of differences in model specification.
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Affiliation(s)
- Stylianos Serghiou
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, Edinburgh, UK
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, 4th Floor, Boston, MA 02115, USA
| | - Yan Yu Tan
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, Edinburgh, UK
| | - Peter Koay
- Ophthalmology Department, St John's Hospital, Howden South Road, Livingston, West Lothian, EH54 6PP, UK; The Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA 94305, USA; Department of Health Research and Policy, Stanford University School of Medicine, 150 Governor's Lane, Stanford, CA 94305, USA; Department of Statistics, Stanford University School of Humanities and Sciences, 390 Serra Mall, Stanford, CA 94305, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
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Santoro L, D’Onofrio F, Flore R, Gasbarrini A, Santoliquido A. Endometriosis and atherosclerosis: what we already know and what we have yet to discover. Am J Obstet Gynecol 2015; 213:326-31. [PMID: 25935777 DOI: 10.1016/j.ajog.2015.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 12/21/2022]
Abstract
The possible association between endometriosis and atherosclerosis represents an emerging topic in the field of women's health. In this Clinical Opinion paper, we analyze this theme focusing on the pathogenetic mechanisms of both diseases, deeply discussing about what is already known about this association and producing starting points about what we consider suitable to research in the near future with regard to cardiovascular involvement in women affected by endometriosis. We have identified 5 reports specifically carried out to investigate the relationship between atherosclerosis and endometriosis; these studies show the presence of subclinical atherosclerosis in women affected by endometriosis, susceptible of regression after surgical removal of endometriosis, with a possible prognostic relevance for variations of cardiovascular risk in these women. However, to date, no studies in literature have been carried out to investigate the real incidence of cardiovascular events in women with endometriosis.
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FitzHenry F, Resnic FS, Robbins SL, Denton J, Nookala L, Meeker D, Ohno-Machado L, Matheny ME. Creating a Common Data Model for Comparative Effectiveness with the Observational Medical Outcomes Partnership. Appl Clin Inform 2015; 6:536-47. [PMID: 26448797 DOI: 10.4338/aci-2014-12-cr-0121] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 07/17/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adoption of a common data model across health systems is a key infrastructure requirement to allow large scale distributed comparative effectiveness analyses. There are a growing number of common data models (CDM), such as Mini-Sentinel, and the Observational Medical Outcomes Partnership (OMOP) CDMs. OBJECTIVES In this case study, we describe the challenges and opportunities of a study specific use of the OMOP CDM by two health systems and describe three comparative effectiveness use cases developed from the CDM. METHODS The project transformed two health system databases (using crosswalks provided) into the OMOP CDM. Cohorts were developed from the transformed CDMs for three comparative effectiveness use case examples. Administrative/billing, demographic, order history, medication, and laboratory were included in the CDM transformation and cohort development rules. RESULTS Record counts per person month are presented for the eligible cohorts, highlighting differences between the civilian and federal datasets, e.g. the federal data set had more outpatient visits per person month (6.44 vs. 2.05 per person month). The count of medications per person month reflected the fact that one system's medications were extracted from orders while the other system had pharmacy fills and medication administration records. The federal system also had a higher prevalence of the conditions in all three use cases. Both systems required manual coding of some types of data to convert to the CDM. CONCLUSIONS The data transformation to the CDM was time consuming and resources required were substantial, beyond requirements for collecting native source data. The need to manually code subsets of data limited the conversion. However, once the native data was converted to the CDM, both systems were then able to use the same queries to identify cohorts. Thus, the CDM minimized the effort to develop cohorts and analyze the results across the sites.
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Affiliation(s)
- F FitzHenry
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center , Nashville, TN ; Department of Biomedical Informatics; Vanderbilt University, Nashville , TN
| | - F S Resnic
- Division of Cardiology, Brigham and Women's Hospital , Boston, MA
| | - S L Robbins
- Division of Cardiology, Brigham and Women's Hospital , Boston, MA
| | - J Denton
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center , Nashville, TN ; Division of General Internal Medicine and Public Health, Vanderbilt University , Nashville, TN
| | - L Nookala
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center , Nashville, TN ; Division of General Internal Medicine and Public Health, Vanderbilt University , Nashville, TN
| | - D Meeker
- Department of Health, RAND Corporation, Santa Monica , CA
| | - L Ohno-Machado
- Division of Biomedical Informatics, University of California , San Diego, CA
| | - M E Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center , Nashville, TN ; Department of Biomedical Informatics; Vanderbilt University, Nashville , TN ; Division of General Internal Medicine and Public Health, Vanderbilt University , Nashville, TN ; Department of Biostatistics, Vanderbilt University , Nashville, TN
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Møllersen MV, Norgård H, Spigset O, Slørdal L. [Cardiovascular safety of non-steroidal anti-inflammatory drugs]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:542-6. [PMID: 25806762 DOI: 10.4045/tidsskr.14.1269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The selective cyclooxygenase (COX)-2 inhibitor rofecoxib was withdrawn from the market in 2004 due to cardiovascular toxicity. We have evaluated data on adverse cardiovascular effects caused by COX-2 inhibitors and other non-steroidal anti-inflammatory drugs (NSAIDs) since 2004. MATERIAL AND METHOD Searches in PubMed (2004-2014) identified 243 relevant articles. Following a selection process, 63 articles were reviewed and evaluated in light of Norwegian practice. RESULTS The results from the studies reviewed are heterogenous. A majority of data indicate that all the selective COX-2 inhibitors, diclofenac and high-dose ibuprofen cause adverse cardiovascular effects to a problematic extent, whereas naproxen consistently exhibits low or no risk. For most NSAIDs high dosage is related to increased risk, and the increase in risk appears to be present from the start of treatment. The effects of length of treatment and predisposition for cardiovascular disease are less clear. INTERPRETATION Adverse cardiovascular effects is as a group effect that applies to all the NSAIDs studied, except for naproxen and low-dose ibuprofen. The traditional classification of NSAIDs as COX-2 selective and non-selective drugs is unsuited for risk stratification. The current pattern of consumption of NSAIDs in the population does not correspond to our knowledge of the increased risk to which patients are exposed.
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Affiliation(s)
- Marie Viel Møllersen
- Institutt for laboratoriemedisin, barne- og kvinnesykdommer Norges teknisk-naturvitenskapelige universitet og Avdeling for klinisk farmakologi
| | - Helle Norgård
- Institutt for laboratoriemedisin, barne- og kvinnesykdommer Norges teknisk-naturvitenskapelige universitet og Avdeling for klinisk farmakologi
| | - Olav Spigset
- Institutt for laboratoriemedisin, barne- og kvinnesykdommer Norges teknisk-naturvitenskapelige universitet og Avdeling for klinisk farmakologi
| | - Lars Slørdal
- Institutt for laboratoriemedisin, barne- og kvinnesykdommer Norges teknisk-naturvitenskapelige universitet og Avdeling for klinisk farmakologi
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Duong M, Salvo F, Pariente A, Abouelfath A, Lassalle R, Droz C, Blin P, Moore N. Usage patterns of 'over-the-counter' vs. prescription-strength nonsteroidal anti-inflammatory drugs in France. Br J Clin Pharmacol 2015; 77:887-95. [PMID: 24102791 DOI: 10.1111/bcp.12239] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/28/2013] [Indexed: 12/24/2022] Open
Abstract
AIMS Most risks of nonsteroidal anti-inflammatory drugs (NSAIDs) are pharmacological, dose and duration dependent. Usage patterns of prescription-only (POM) or 'over-the-counter (OTC)' NSAIDs may influence risks, but are not commonly described. METHODS The Echantillon Généraliste de Bénéficiaires database, the permanent 1/97 representative sample from the French national healthcare insurance systems, was queried over 2009-2010 to identify usage patterns, concomitant chronic diseases and cardiovascular medication in OTC and POM NSAID users. RESULTS Over 2 years, 229 477 of 526 108 patients had at least one NSAID dispensation; 44 484 patients (19%) were dispensed only OTC NSAIDs (93% ibuprofen) and 121 208 (53%) only POM NSAIDs. The OTC users were younger (39.9 vs. 47.4 years old) and more often female (57 vs. 53%); 69% of OTC users and 49% of POM users had only one dispensation. A mean of 14.6 defined daily doses (DDD) were dispensed over 2 years for OTC vs. 53 for POM; 93% OTC vs. 60% POM patients bought ≤ 30 DDD over 2 years, and 1.5 vs. 12% bought ≥ 90 DDD. Chronic comorbidities were found in 19% of OTC users vs. 28% of POM users; 24 vs. 37% had at least one dispensation of a cardiovascular drug over the 2 years. CONCLUSIONS Most of the use of NSAIDs appears to be short term, especially for OTC-type NSAIDs, such as ibuprofen. The validity of risk estimates for NSAIDs extrapolated from clinical trials or from observational studies not including OTC-type usage may need to be revised.
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Fabule J, Adebajo A. Comparative evaluation of cardiovascular outcomes in patients with osteoarthritis and rheumatoid arthritis on recommended doses of nonsteroidal anti-inflammatory drugs. Ther Adv Musculoskelet Dis 2014; 6:111-30. [PMID: 25342992 DOI: 10.1177/1759720x14541668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIMS AND OBJECTIVES We conducted an analysis to explore whether the cardiovascular outcomes associated with nonsteroidal anti-inflammatory drugs (NSAIDs), when used in licensed doses by patients with osteoarthritis or rheumatoid arthritis, was class or compound dependent. METHODS Using the Ovid technology search engine, we conducted a search of the literature for relevant studies published between 1995 and 2011. We also retrieved further studies following manual searches. The primary endpoint was major vascular events and the secondary endpoints were stroke, hypertension and congestive heart failure. A total of 19 studies were analysed. Studies conducted in the osteoarthritis and rheumatoid arthritis patients' population that reported on cardiovascular events were included in the analysis. The analysis was conducted using the software Review Manager 5.1 and Cochrane methodology. RESULTS Using the primary endpoint of major vascular events (MVE) and a prespecified cutoff point of 1.30, diclofenac (versus 1 comparator) and rofecoxib (versus 2 comparators) had increased risk for MVE [odds ratio (OR) >1.30]. Using the same criteria, diclofenac (versus 1 comparator) had an increased risk of myocardial infarction (MI). Although celecoxib had a slightly increased risk for MI (OR 1.33, versus 1 comparator), the confidence interval included 1 and was not significant. For the secondary endpoints, etoricoxib and rofecoxib were significantly worse off for HT (versus 1 comparator each) and naproxen was significantly worse off for stroke (versus 1 comparator). Although ibuprofen was worse off for HT (versus 1 comparator) the increased risk was not significant. CONCLUSION From the analysis conducted, it appears that the risk for cardiovascular events in arthritis patients on licensed doses of NSAIDs varies considerably and is likely to depend on the individual compound.
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Affiliation(s)
- John Fabule
- Astrazeneca - Global Medical Affairs, 2 Kingdom Street, London W2 6BD, UK
| | - Ade Adebajo
- Academic Rheumatology Group, Faculty of Medicine, University of Sheffield and Barnsley Hospital NHS Foundation Trust, Barnsley, UK
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Kim HS, Kim T, Kim MK, Suh DH, Chung HH, Song YS. Cyclooxygenase-1 and -2: molecular targets for cervical neoplasia. J Cancer Prev 2014; 18:123-34. [PMID: 25337538 PMCID: PMC4189449 DOI: 10.15430/jcp.2013.18.2.123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 01/29/2023] Open
Abstract
Cyclooxygenase (COX) is a key enzyme responsible for inflammation, converting arachidonic acid to prostaglandin and thromboxane. COX has at least two isoforms, COX-1 and COX-2. While COX-1 is constitutively expressed in most tissues for maintaining physiologic homeostasis, COX-2 is induced by inflammatory stimuli including cytokines and growth factors. Many studies have shown that COX-2 contributes to cancer development and progression in various types of malignancy including cervical cancer. Human papillomavirus, a necessary cause of cervical cancer, induces COX-2 expression via E5, E6 and E7 oncoproteins, which leads to prostaglandin E2 increase and the loss of E-cadherin, promotes cell proliferation and production of vascular endothelial growth factor. It is strongly suggested that COX-2 is associated with cancer development and progression such as lymph node metastasis. Many studies have suggested that non-selective COX-2 inhibitors such as non-steroidal anti-inflammatory drugs (NSAIDs), and selective COX-2 inhibitors might show anti-cancer activity in COX-2 -dependent and -independent manners. Two phase II trials for patients with locally advanced cervical cancer showed that celecoxib increased toxicities associated with radiotherapy. Contrary to these discouraging results, two phase II clinical trials, using rofecoxib and celecoxib, demonstrated the promising chemopreventive effect for patients with cervical intraepithelial neoplasia 2 or 3. However, these agents cause a rare, but serious, cardiovascular complication in spite of gastrointestinal protection in comparison with NSAIDs. Recent pharmacogenomic studies have showed that the new strategy for overcoming the limitation in clinical application of COX-2 inhibitors shed light on the use of them as a chemopreventive method.
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Affiliation(s)
- Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul
| | - Taehun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul
| | - Mi-Kyung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul ; Cancer Research Institute, Seoul National University College of Medicine ; Major in Biomodulation, World Class University, Seoul National University, Seoul, Korea
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Madigan D, Ryan PB, Schuemie M. Does design matter? Systematic evaluation of the impact of analytical choices on effect estimates in observational studies. Ther Adv Drug Saf 2014; 4:53-62. [PMID: 25083251 DOI: 10.1177/2042098613477445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical studies that use observational databases, such as administrative claims and electronic health records, to evaluate the effects of medical products have become commonplace. These studies begin by selecting a particular study design, such as a case control, cohort, or self-controlled design, and different authors can and do choose different designs for the same clinical question. Furthermore, published papers invariably report the study design but do not discuss the rationale for the specific choice. Studies of the same clinical question with different designs, however, can generate different results, sometimes with strikingly different implications. Even within a specific study design, authors make many different analytic choices and these too can profoundly impact results. In this paper, we systematically study heterogeneity due to the type of study design and due to analytic choices within study design. METHODS AND FINDINGS We conducted our analysis in 10 observational healthcare databases but mostly present our results in the context of the GE Centricity EMR database, an electronic health record database containing data for 11.2 million lives. We considered the impact of three different study design choices on estimates of associations between bisphosphonates and four particular health outcomes for which there is no evidence of an association. We show that applying alternative study designs can yield discrepant results, in terms of direction and significance of association. We also highlight that while traditional univariate sensitivity analysis may not show substantial variation, systematic assessment of all analytical choices within a study design can yield inconsistent results ranging from statistically significant decreased risk to statistically significant increased risk. Our findings show that clinical studies using observational databases can be sensitive both to study design choices and to specific analytic choices within study design. CONCLUSION More attention is needed to consider how design choices may be impacting results and, when possible, investigators should examine a wide array of possible choices to confirm that significant findings are consistently identified.
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Affiliation(s)
- David Madigan
- Professor and Chair, Department of Statistics, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA
| | - Patrick B Ryan
- Observational Medical Outcomes Partnership, Foundation for the National Institutes of Health, Bethesda, MD and Janssen Research and Development LLC, Titusville, NJ, USA
| | - Martijn Schuemie
- Observational Medical Outcomes Partnership, Foundation for the National Institutes of Health, Bethesda, MD and Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Varas-Lorenzo C, Riera-Guardia N, Calingaert B, Castellsague J, Salvo F, Nicotra F, Sturkenboom M, Perez-Gutthann S. Myocardial infarction and individual nonsteroidal anti-inflammatory drugs meta-analysis of observational studies. Pharmacoepidemiol Drug Saf 2014; 22:559-70. [PMID: 23616423 PMCID: PMC3749466 DOI: 10.1002/pds.3437] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 01/19/2013] [Accepted: 02/21/2013] [Indexed: 12/23/2022]
Abstract
Objective To conduct a systematic review of observational studies on the risk of acute myocardial infarction (AMI) with use of individual nonsteroidal anti-inflammatory drugs (NSAIDs). Methods A search of Medline (PubMed) for observational studies published from 1990 to 2011 identified 3829 articles; 31 reported relative risk (RR) of AMI with use of individual NSAIDs versus nonuse of NSAIDs. Information abstracted in a standardized form from 25 publications was used for the meta-analysis on 18 independent study populations. Results Random-effects RR (95% confidence interval (CI)) was lowest for naproxen 1.06 (0.94–1.20), followed by celecoxib 1.12 (1.00–1.24), ibuprofen 1.14 (0.98–1.31), meloxicam 1.25 (1.04–1.49), rofecoxib 1.34 (1.22–1.48), diclofenac 1.38 (1.26–1.52), indometacin 1.40 (1.21–1.62), etodolac 1.55 (1.16–2.06), and etoricoxib 1.97 (1.35–2.89). Heterogeneity between studies was present. For new users, RRs (95% CIs) were for naproxen, 0.85 (0.73–1.00); ibuprofen, 1.20 (0.97–1.48); celecoxib, 1.23 (1.00–1.52); diclofenac, 1.41 (1.08–1.86); and rofecoxib, 1.43 (1.21–1.66). Except for naproxen, higher risk was generally associated with higher doses, as defined in each study, overall and in patients with prior coronary heart disease. Low and high doses of diclofenac and rofecoxib were associated with high risk of AMI, with dose–response relationship for rofecoxib. In patients with prior coronary heart disease, except for naproxen, duration of use ≤3 months was associated with an increased risk of AMI. Conclusions Most frequently NSAIDs used in clinical practice, except naproxen, are associated with an increased risk of AMI at high doses or in persons with diagnosed coronary heart disease. For diclofenac and rofecoxib, the risk was increased at low and high doses. Copyright © 2013 John Wiley & Sons, Ltd.
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Affiliation(s)
- Cristina Varas-Lorenzo
- RTI Health SolutionsBarcelona, Spain
- *Correspondence to: Cristina Varas-Lorenzo, MD, PhD, MSc, RTI Health Solutions, Travesera de Gracia 56, Atico 1º, 08006, Barcelona, Spain 02451. E-mail:
| | | | | | | | | | - Federica Nicotra
- Department of Statistics, Biostatistics and Epidemiology Unit, University of Milano-BicoccaMilan, Italy
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Schjerning Olsen AM, Fosbøl EL, Gislason GH. The impact of NSAID treatment on cardiovascular risk - insight from Danish observational data. Basic Clin Pharmacol Toxicol 2014; 115:179-84. [PMID: 24690187 DOI: 10.1111/bcpt.12244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/13/2014] [Indexed: 12/12/2022]
Abstract
This MiniReview describes the present evidence for the relationship between cardiovascular risk and use of non-steroidal anti-inflammatory drugs (NSAIDs) with special focus using Danish register-based data. NSAIDs are among the most widely used drugs worldwide and mainly used for management of pain and inflammatory conditions. Through the past decade, much attention has been given to the cardiovascular safety of these drugs, and several studies have shown increased risk of adverse cardiovascular effects associated with NSAID use. Current guidelines discourage any use of NSAIDs in patients with cardiovascular disease, yet over a period of 8-10 years, 35-44% of patients with myocardial infarction or heart failure were exposed to NSAIDs in Denmark. Furthermore, NSAID use was associated with an increased risk of death or myocardial infarction by up to 5 times that of non-users. There was also a clear indication for a dose-related response in risk associated with NSAID therapy, supporting a causal association. Notably, the cardiovascular risk associated with NSAID treatment was prevalent at start of treatment, suggesting no safe treatment window for NSAIDs in patients with cardiovascular disease. Thus, evidence from observational studies is accumulating, suggesting that NSAIDs are a major public health concern due to the widespread use of these drugs. Although it seems unlikely that we can completely avoid use of NSAIDs, even among high-risk patients, these results highlight the importance of balancing the benefit versus the risk of treatment before initiating NSAID treatment.
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Singh Bahia M, Kumar Katare Y, Silakari O, Vyas B, Silakari P. Inhibitors of Microsomal Prostaglandin E2
Synthase-1 Enzyme as Emerging Anti-Inflammatory Candidates. Med Res Rev 2014; 34:825-55. [DOI: 10.1002/med.21306] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Malkeet Singh Bahia
- Molecular Modelling Lab (MML); Department of Pharmaceutical Sciences and Drug Research; Punjabi University; Patiala Punjab 147002 India
| | - Yogesh Kumar Katare
- Radharaman Institute of Pharmaceutical Sciences; Bhopal Madhya Pradesh 462046 India
| | - Om Silakari
- Molecular Modelling Lab (MML); Department of Pharmaceutical Sciences and Drug Research; Punjabi University; Patiala Punjab 147002 India
| | - Bhawna Vyas
- Department of Chemistry; Punjabi University; Patiala Punjab 147002 India
| | - Pragati Silakari
- Adina institute of Pharmaceutical Sciences; Sagar Madhya Pradesh (M.P.) 470001 India
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Gadzhanova S, Ilomäki J, Roughead EE. COX-2 inhibitor and non-selective NSAID use in those at increased risk of NSAID-related adverse events: a retrospective database study. Drugs Aging 2014. [PMID: 23179898 DOI: 10.1007/s40266-012-0037-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Adverse events related to analgesic use represent a challenge for optimizing treatment of pain in older people. OBJECTIVE The aim of this study was to determine whether non-selective non-steroidal anti-inflammatory drug (NS-NSAID) and cyclo-oxygenase (COX)-2 inhibitor use is appropriately targeted in those with a prior history of gastrointestinal (GI) events, myocardial infarction (MI) or stroke. METHODS A retrospective study of pharmacy claims data from the Australian Government Department of Veterans' Affairs was conducted, involving 288,912 veterans aged 55 years and over. Analgesic utilization from 2007 to 2009 was assessed. Three risk cohorts (veterans with prior hospitalization for GI bleed, MI or stroke) and a low-risk cohort were identified. Poisson regression was applied to test for a linear trend over the study period. RESULTS The prevalence of analgesics dispensed in the overall study population was approximately 34 % between 2007 and 2009. COX-2 inhibitors were more widely dispensed than NS-NSAIDs in all those at risk of NSAID-related adverse events. At the end of 2009, the ratio was 5.1 % to 2.5 % in the GI cohort, 3.6 % to 3.2 % in the MI cohort and 3.6 % to 2.6 % in the stroke cohort. CONCLUSIONS Although COX-2 inhibitors appeared to be preferred over NS-NSAIDs in those with a prior history of GI events, 2.5 % of patients were still using an NS-NSAID at the end of the study period. Consistent with treatment guidelines, in most of these cases, these drugs were co-dispensed with proton pump inhibitors. COX-2 inhibitors were used at slightly higher rates than NS-NSAIDs in those with a prior history of MI or stroke, which is not consistent with guidelines recommending NS-NSAID use.
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Affiliation(s)
- Svetla Gadzhanova
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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Moore N, Salvo F, Duong M, Blin P, Pariente A. Cardiovascular risks associated with low-dose ibuprofen and diclofenac as used OTC. Expert Opin Drug Saf 2013; 13:167-79. [DOI: 10.1517/14740338.2014.846324] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Stang PE, Ryan PB, Overhage JM, Schuemie MJ, Hartzema AG, Welebob E. Variation in Choice of Study Design: Findings from the Epidemiology Design Decision Inventory and Evaluation (EDDIE) Survey. Drug Saf 2013; 36 Suppl 1:S15-25. [PMID: 24166220 DOI: 10.1007/s40264-013-0103-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul E Stang
- Janssen Research and Development LLC, Titusville, NJ, USA,
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Rother M, Conaghan PG. A Randomized, Double-blind, Phase III Trial in Moderate Osteoarthritis Knee Pain Comparing Topical Ketoprofen Gel with Ketoprofen-free Gel. J Rheumatol 2013; 40:1742-8. [DOI: 10.3899/jrheum.130192] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective.This randomized, double-blind, phase III study evaluated the efficacy and safety of ketoprofen in an ultradeformable vesicle gel compared with ketoprofen-free gel in osteoarthritis (OA) knee pain.Methods.Patients with American College of Rheumatology-defined OA of the knee and moderate pain were randomized to receive 100 mg ketoprofen in 4.4 g transfersome gel (IDEA-033) or 4.4 g ketoprofen-free vehicle (TDT 064) topically, twice daily, for 12 weeks. The primary endpoint was mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score from baseline to Week 12.Results.Patients (n = 555) were randomized and treated. Mean baseline WOMAC pain scores were 5.2 (SD 1.0) for IDEA-033 and 5.3 (SD 1.0) for TDT 064. Mean change in WOMAC pain scores from baseline to Week 12 was 38.6% for IDEA-033 and 44.6% for TDT 064 (Mann-Whitney estimator 0.4505; p = 0.022). Both groups reported progressive decreases in pain and improvements in function and stiffness. Mean baseline WOMAC function scores decreased from 5.4 to 3.4 with IDEA-033 and 3.1 with TDT 064 at Week 12. The proportion of patients achieving ≥ 50% decrease in WOMAC pain score from baseline at Week 12 was 41.2% (95% CI 0.35–0.47) with IDEA-033 and 50.5% (95% CI 0.45–0.57) with TDT 064. Mild skin and subcutaneous tissue disorders were the most frequently reported treatment-related adverse events (AE).Conclusions.IDEA-033 was inferior to drug-free gel (TDT 064) in relieving moderate OA knee pain and improving joint function (Clinical TrialsNCT00722852).
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Madigan D, Ryan PB, Schuemie M, Stang PE, Overhage JM, Hartzema AG, Suchard MA, DuMouchel W, Berlin JA. Evaluating the impact of database heterogeneity on observational study results. Am J Epidemiol 2013; 178:645-51. [PMID: 23648805 DOI: 10.1093/aje/kwt010] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Clinical studies that use observational databases to evaluate the effects of medical products have become commonplace. Such studies begin by selecting a particular database, a decision that published papers invariably report but do not discuss. Studies of the same issue in different databases, however, can and do generate different results, sometimes with strikingly different clinical implications. In this paper, we systematically study heterogeneity among databases, holding other study methods constant, by exploring relative risk estimates for 53 drug-outcome pairs and 2 widely used study designs (cohort studies and self-controlled case series) across 10 observational databases. When holding the study design constant, our analysis shows that estimated relative risks range from a statistically significant decreased risk to a statistically significant increased risk in 11 of 53 (21%) of drug-outcome pairs that use a cohort design and 19 of 53 (36%) of drug-outcome pairs that use a self-controlled case series design. This exceeds the proportion of pairs that were consistent across databases in both direction and statistical significance, which was 9 of 53 (17%) for cohort studies and 5 of 53 (9%) for self-controlled case series. Our findings show that clinical studies that use observational databases can be sensitive to the choice of database. More attention is needed to consider how the choice of data source may be affecting results.
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Affiliation(s)
- David Madigan
- Department of Statistics, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
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Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev (Pavia) 2013; 5:e2. [PMID: 23705060 PMCID: PMC3662262 DOI: 10.4081/or.2013.e2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/12/2012] [Indexed: 01/24/2023] Open
Abstract
Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden.
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Affiliation(s)
- Dennis C Crawford
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
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MacDonald TM, Mackenzie IS, Wei L, Hawkey CJ, Ford I. Methodology of a large prospective, randomised, open, blinded endpoint streamlined safety study of celecoxib versus traditional non-steroidal anti-inflammatory drugs in patients with osteoarthritis or rheumatoid arthritis: protocol of the standard care versus celecoxib outcome trial (SCOT). BMJ Open 2013; 3:e002295. [PMID: 23364320 PMCID: PMC3563118 DOI: 10.1136/bmjopen-2012-002295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Cyclooxygenase 2 (COX-2) inhibitors have less upper gastrointestinal toxicity than traditional non-steroidal anti-inflammatory drugs (NSAIDs). However, both COX-2 inhibitors and traditional NSAIDs may be associated with adverse cardiovascular side effects. Data from randomised and observational studies suggest that celecoxib has similar cardiovascular toxicity to traditional NSAIDs. The overall safety balance of a strategy of celecoxib therapy versus traditional NSAID therapy is unknown. The European Medicines Agency requested studies of the cardiovascular safety of celecoxib within Europe. The Standard care versus Celecoxib Outcome Trial (SCOT) compares the cardiovascular safety of celecoxib with traditional NSAID therapy in the setting of the European Union healthcare system. METHODS AND ANALYSIS SCOT is a large streamlined safety study conducted in Scotland, England, Denmark and the Netherlands using the Prospective Randomised Open Blinded Endpoint design. Patients aged over 60 years with osteoarthritis or rheumatoid arthritis, free from established cardiovascular disease and requiring chronic NSAID therapy, are randomised to celecoxib or their previous traditional NSAID. They are then followed up for events by record-linkage within their normal healthcare setting. The hypothesis is non-inferiority with a confidence limit of 1.4. The primary endpoint is the first occurrence of hospitalisation or death for the Anti-Platelet Trialists' Collaboration (APTC) cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. Secondary endpoints are (1) first hospitalisation or death for upper gastrointestinal ulcer complications (bleeding, perforation or obstruction); (2) first occurrence of hospitalised upper gastrointestinal ulcer complications or APTC endpoint; (3) first hospitalisation for heart failure; (4) first hospitalisation for APTC endpoint plus heart failure; (5) all-cause mortality and (6) first hospitalisation for new or worsening renal failure. ETHICS AND DISSEMINATION SCOT has been approved by the relevant ethics committees. The trial results will be published in a peer-reviewed scientific journal. CLINICAL TRIALS REGISTRATION NUMBER Clinicaltrials.gov (NCT00447759).
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Affiliation(s)
- Thomas M MacDonald
- Medicines Monitoring Unit (MEMO), Medical Research Institute, University of Dundee, Dundee, UK
| | - Isla S Mackenzie
- Medicines Monitoring Unit (MEMO), Medical Research Institute, University of Dundee, Dundee, UK
| | - Li Wei
- School of Pharmacy, UCL, London, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Anzellotti P, Capone ML, Jeyam A, Tacconelli S, Bruno A, Tontodonati P, Di Francesco L, Grossi L, Renda G, Merciaro G, Di Gregorio P, Price TS, Garcia Rodriguez LA, Patrignani P. Low-dose naproxen interferes with the antiplatelet effects of aspirin in healthy subjects: recommendations to minimize the functional consequences. ACTA ACUST UNITED AC 2013; 63:850-9. [PMID: 21360514 DOI: 10.1002/art.30175] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether low-dose naproxen sodium (220 mg twice a day) interferes with aspirin's antiplatelet effect in healthy subjects. METHODS We performed a crossover, open-label study in 9 healthy volunteers. They received for 6 days 3 different treatments separated by 14 days of washout: 1) naproxen 2 hours before aspirin, 2) aspirin 2 hours before naproxen, and 3) aspirin alone. The primary end point was the assessment of serum thromboxane B(2) (TXB(2)) 24 hours after the administration of naproxen 2 hours before aspirin on day 6 of treatment. In 5 volunteers, the rate of recovery of TXB(2) generation (up to 72 hours after drug discontinuation) was assessed in serum and in platelet-rich plasma stimulated with arachidonic acid (AA) or collagen. RESULTS Twenty-four hours after the last dosing on day 6 in volunteers receiving aspirin alone or aspirin before naproxen, serum TXB(2) was almost completely inhibited (median [range] 99.1% [97.4-99.4%] and 99.1% [98.0-99.7%], respectively). Naproxen given before aspirin caused a slightly lower inhibition of serum TXB(2) (median [range] 98.0% [90.6-99.4%]) than aspirin alone (P = 0.0007) or aspirin before naproxen (P = 0.0045). All treatments produced a maximal inhibition of AA-induced platelet aggregation. At 24 hours, compared with baseline, collagen-induced platelet aggregation was still inhibited by aspirin alone (P = 0.0003), but not by aspirin given 2 hours before or after naproxen. Compared with administration of aspirin alone, the sequential administration of naproxen and aspirin caused a significant parallel upward shift of the regression lines describing the recovery of platelet TXB(2). CONCLUSION Sequential administration of 220 mg naproxen twice a day and low-dose aspirin interferes with the irreversible inhibition of platelet cyclooxygenase 1 afforded by aspirin. The interaction was smaller when giving naproxen 2 hours after aspirin. The clinical consequences of these 2 schedules of administration of aspirin with naproxen remain to be studied in randomized clinical trials.
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Affiliation(s)
- Paola Anzellotti
- G. d'Annunzio University-Chieti and G. d'Annunzio University Foundation, Chieti, Italy.
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McGettigan P, Henry D. Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med 2013; 10:e1001388. [PMID: 23424288 PMCID: PMC3570554 DOI: 10.1371/journal.pmed.1001388] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/03/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND FINDINGS Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%. CONCLUSIONS Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.
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Affiliation(s)
- Patricia McGettigan
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - David Henry
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- * E-mail:
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