Comment on: "Coxibs Refocus Attention on the Cardiovascular Risks of Non-Aspirin NSAIDs"/Reply

• Published in: American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2017-12, Vol.17 (6), p.493-498
• Main Authors: Urtasun, Martin A, Prozzi, Guillermo R, Marin, Gustavo H, Buschiazzo, Hector O, Canas, Martin, Dorati, Cristian M, Mordujovich, Perla, Thomas, Dixon, Zachariah, Seeba, Sundararaj, Kishore Gnana Sam, Cuyk, Matthew Van, Cooper, Jason C
• Format: Article
• Language: English
• Subjects: Analgesics; Arthritis; Aspirin; Conflicts of interest; Drug dosages; Drug withdrawal; Hemorrhage; Nonsteroidal anti-inflammatory drugs; Osteoarthritis
• ISSN: 1175-3277; 1179-187X
• DOI: 10.1007/s40256-017-0235-2

According to the authors' conclusion, "at moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety", implying that their results validate the safe use of celecoxib at the same level as naproxen or ibuprofen. [...]the average dose of celecoxib (209 mg/day) used was practically equal to the minimum dose, whereas those of naproxen (852 mg/day) and ibuprofen (2045 mg/day) showed that a great number of patients used the higher dose. [...]it is possible that the anti-inflammatory and analgesic doses used were not equivalent, which complicates the interpretation of adverse event rates. 2Cardiovascular Adverse Events In the PRECISION trial, 45% of patients were using aspirin up to 325 mg/day because they had previous CVD or were at high cardiovascular risk. [...]the cardiovascular risk of celecoxib (at a typical dose of 400 mg/day) compared with placebo is estimated at a relative risk of 1.36 (95% CI 1.0-1.84; p = 0.05) in the most comprehensive meta-analysis available [5], an effect size that coincides with the chosen Delta and that, therefore, would be considered 'acceptable damage' from the trial design itself.