Public Release: 

COX-2 inhibitor could be safest anti-inflammatory drug for older people

NB: Please note that if you are outside North America, the embargo for LANCET press material is 0001 hours UK Time Friday 28 May 2004


A Canadian study involving over 130,000 older people in this week's issue of THE LANCET shows how the anti-inflammatory cyclo-oxygenase-2 (COX-2) inhibitor celecoxib may have a lower risk of congestive heart failure compared with other non-steroidal anti-inflammatory drugs.

Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used by older people to relieve arthritis symptoms, but are associated with an increased risk of congestive heart failure. Less is known about the cardiovascular effects of COX-2 inhibitors, a newer group of NSAIDS.

Muhammad Mamdani from the Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada, and colleagues assessed retrospectively the risk of hospital admission for heart failure for around 14,500 people using the COX-2 inhibitor rofecoxib, around 19,000 using the COX-2 inhibitor celecoxib, and around 5400 people who had been using non-selective NSAIDs. 100,000 people not using NSAIDs were used as a control group.

Compared with non-NSAID users, patients on rofecoxib had an 80% increase in hospital admission for heart failure; people using non-selective NSAIDS had a 40% increased admission risk. However, users of celecoxib had the same rate of hospital admission for heart failure as people who had never used NSAIDs.

Dr Mamdani comments: "our findings suggest significant differences between non-selective NSAIDs and individual COX-2 inhibitors with respect to risk of admission for congestive heart failure. The clinical relevance of these findings, in view of the widespread use of the drugs, warrants the implementation of large-scale randomised controlled trials to examine this issue further".


Lancet 2004; 363: 1751-56

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