 Since the
recall of Vioxx by Merck in September,
2004 and then a ban by the FDA on the sale of Bextra,
all painkillers have come under increasing scrutiny. While Celebrex continues to be available, not many arthritis patients are convinced that it is worthwhile to take the risk considering its side effects on the heart. So people
seeking pain relief from arthritis have rushed to other painkillers like
Mobic,
ibuprofen,
Prexige,
Arcoxia, and others. However, it seems that all painkillers have serious side effects on the heart.
Contrary to prior understanding, Peter Jüni, an expert clinical epidemiology, reports in BMJ similar risk of myocardial infarction for
celecoxib (Celebrex), rofecoxib (Vioxx), ibuprofen and
naproxen
(Aleve), but a somewhat higher risk with
diclofenac (sold as
Cataflam,
Voltaren, and Voltaren-XR). As everyone knows,
Celebrex is available by prescription (though it carries a
black box
warning, but ibuprofen, Aleve, and diclofenac brands are available over the counter.
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 The scientists also found risk of myocardial infarction for the highly selective
lumiracoxib (sold as Prexige by Novartis). No data on the cardiovascular safety of
etoricoxib (sold as Arcoxia by Merck)
from large trials have been published so far, but Jüni says that
"...no news is no longer good news: patients and doctors are anxious to know whether cardiotoxicity is a class effect applicable to any
COX 2
inhibitor, or even to NSAIDs in general." Interestingly enough, the researchers found lower mortality in patients treated with celecoxib (Celebrex) than with rofecoxib (Vioxx) or traditional NSAIDs. This was the main reason that the FDA has left Celebrex on the market while forcing a recall of Bextra. This part of the analysis was conducted by Marie Hudson, an expert in epidemiology; Hugues Richard, biostatistician, and Louise
Pilote.
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The analysis on diclofenac and ibuprofen was done by Julia Hippisley-Cox, an expert in clinical epidemiology and general practice and Carol Coupland, who specializes in medical statistics. They found that increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease
(South
Beach Heart Program). Their results reconfirm an
increased risk of myocardial infarction associated with current use of
rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, the scientist warn, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs.
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