Key result
Selective COX-2 inhibitors did not significantly alter the risk of cerebrovascular events compared to placebo (OR 1.03; 95% CI 0.71-1.50) or non-selective NSAIDs (OR 0.86; 95% CI 0.64-1.16).
Why the study?
Do selective COX-2 inhibitors increase the risk of cerebrovascular events compared to placebo or non-selective NSAIDs?
Meta-Analysis (n=88,116)
Do selective COX-2 inhibitors increase the risk of cerebrovascular events compared to placebo or non-selective NSAIDs?
Odds Ratio: 1.03 (95% CI 0.71–1.5)
Supports cerebrovascular safety of selective COX-2 inhibitors; confirms their thrombotic risk is driven primarily by myocardial infarction.
OBJECTIVES: To evaluate the risk of cerebrovascular events (CVEs) associated with selective cyclooxygenase-2 inhibitors (coxibs). METHOD: Systematic review and meta-analysis of randomized controlled trials (RCTs). A fixed-effect model was used to estimate the odds ratios (ORs) for risk of CVE associated with coxibs compared against placebo, non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and other coxibs. RESULTS: Forty trials (88 116 patients) were included in the meta-analysis. The overall pooled OR for CVE for any coxib against placebo was 1.03 (95% CI: 0.71, 1.50). Comparing individual coxibs against placebo, we found that celecoxib, rofecoxib, etoricoxib and lumiracoxib were associated with higher CVE risks and valdecoxib was associated with a lower CVE risk, although there were no significant differences detected. There was also no significant difference in risk of CVE when comparing coxibs against any non-selective NSAIDs; the corresponding pooled OR was 0.86 (95% CI: 0.64, 1.16). CONCLUSION: On the basis of a detailed analysis of available RCTs, there does not appear to be any significant difference in risk of CVEs associated with coxibs when compared against placebo or non-selective NSAIDs. It is likely that the increased risk of thrombotic vascular events associated with coxibs is largely attributable to an increased risk of myocardial infarction, rather than CVEs.
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Chen et al. (2006) reported a meta-analysis. Selective cyclooxygenase-2 inhibitors (coxibs) vs. Placebo or non-selective NSAIDs was evaluated on Cerebrovascular events (CVEs) (OR 1.03, 95% CI 0.71, 1.50). Selective COX-2 inhibitors did not significantly alter the risk of cerebrovascular events compared to placebo (OR 1.03; 95% CI 0.71-1.50) or non-selective NSAIDs (OR 0.86; 95% CI 0.64-1.16).
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