| Todas las causas de mortalidad en ancianos veteranos Australianos que usan AINES COX-2 selectivos o no selectivos: estudio longitudinal |
All-cause mortality of elderly Australian veterans using COX-2 selective or non-selective NSAIDs: a longitudinal study.
Kerr SJ, Rowett DS, Sayer GP, Whicker SD, Saltman DC, Mant A.
National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW 2052, Australia.
Br J Clin Pharmacol. 2011 Jun;71(6):936-42. doi: 10.1111/j.1365-2125.2010.03702.x. Epub 2010 May 6.
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Previous studies have found varying impact of exposure to COX-2 selective and non-selective NSAIDs. WHAT THIS STUDY ADDS: * Individuals receiving a COX-2 selective NSAID had an increased risk of all-cause mortality after correction for age, sex and cardiovascular risk as measured by co-prescription. * Despite differences in the pharmacokinetic properties of the COX-2 selective inhibitor drugs, our study lends no support to clinicians preferring any one COX-2 selective inhibitor drug, or substituting one for another on the grounds of mortality risk alone. * The Australian Department of Veterans' Affairs data sets make it possible to conduct timely record linkage studies of all-cause mortality from use of medicines in a large and clinically relevant population. AIM: To determine hazard ratios for all-cause mortality in elderly Australian veterans taking COX-2 selective and non-selective NSAIDs. METHODS: Patient cohorts were constructed from claims databases (1997 to 2007) for veterans and dependants with full treatment entitlement irrespective of military service. Patients were grouped by initial exposure: celecoxib, rofecoxib, meloxicam, diclofenac, non-selective NSAID. A reference group was constructed of patients receiving glaucoma/hypothyroid medications and none of the study medications. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for each exposure group against each of the reference group. The final model was adjusted for age, gender and co-prescription as a surrogate for cardiovascular risk. Patients were censored if the gap in supply of study prescription exceeded 30 days or if another study medication was initiated. The outcome measure in all analyses was death. RESULTS: Hazard ratios and 95% CIs, adjusted for age, gender and cardiovascular risk, for each group relative to the reference group were: celecoxib 1.39 (1.25, 1.55), diclofenac 1.44 (1.28, 1.62), meloxicam 1.49 (1.25, 1.78), rofecoxib 1.58 (1.39, 1.79), non-selective NSAIDs 1.76 (1.59, 1.94). CONCLUSIONS: In this large cohort of Australian veterans exposed to COX-2 selective and non-selective NSAIDs, there was a significant increased mortality risk for those exposed to either COX-2-selective or non-selective NSAIDs relative to those exposed to unrelated (glaucoma/hypothyroid) medications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099381/pdf/bcp0071-0936.pdf
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| Uso de AINES que elevan el riesgo cardiovascular: una revisión de las ventas y las listas de medicamentos esenciales en los países de ingreso bajo, mediano y alto. |
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.
McGettigan P, Henry D.
William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
PLoS Med. 2013 Feb;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570554/pdf/pmed.
1001388.pdf
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| Revisión sobre drogas analgésicas, antiinflamatorios no esteroideas |
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