Comprehensive analyses of the benefits and risks of NSAIDs

Charles H. Hennekens, MD, DrPH, the first Sir Richard Doll professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University has published in the current issue of The Lancet the most comprehensive analyses of the benefits and risks of non-steroidal anti-inflammatory drugs (NSAIDs), which include cyclo-oxygenase-2 inhibitors (coxibs).

Hennekens and colleagues from around the world, under the direction of the Clinical Trial Service and Epidemiology Studies Unit at the University of Oxford, conducted a world-wide meta-analyses using individual participant data from 280 trials of NSAIDs vs. placebo and 474 trials of NSAID vs. another NSAID, which involved a total of 353,809 participants and a total of 233,798 person-years. These results address risks and benefits of drugs used for relief of inflammatory arthritis including cardiovascular disease and other relevant outcomes such as gastrointestinal effects.

"The vascular risks of high-dose diclofenac and ibuprofen are comparable to coxibs, while high-dose naproxen is associated with less vascular risk than other NSAIDs," said Hennekens. "Although NSAIDs increase vascular and gastrointestinal risks, their magnitude can be predicted, which may help guide clinical decision-making."

David J. Bjorkman, MD, MSPH, dean of the Charles E. Schmidt College of Medicine at FAU and a gastroenterologist noted that "these are the most comprehensive analyses ever conducted of the benefits and risks of NSAIDs, which include coxibs, and should help guide healthcare providers in their prescribing patterns."

Hennekens concluded that "from a clinical and policy perspective, the available data suggest that for relief of pain of inflammatory arthritis, naproxen may have the best benefit-to-risk ratio on cardiovascular disease (CVD). In contrast to naproxen, other traditional NSAIDS and coxibs confer similar moderately increased risks of CVD. At present, individual clinical judgments about coxibs and nonselective NSAIDs should not be limited to risks of CVD. They should also include concerns about non-CVD risks, such as gastrointestinal bleeding and other benefits, including improved quality of life resulting from decreases in impairment from musculoskeletal pain syndromes."

Science Watch ranked Hennekens as the third most widely cited medical researcher in the world from 1995-2005, and five of the top 20 were his former trainees and/or fellows. In addition, in 2012 Science Heroes, ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives.

Source:

Florida Atlantic University

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