Key result
In patients with rheumatoid arthritis, both celecoxib and meloxicam altered lipid profiles and reduced C-reactive protein, but meloxicam significantly increased serum creatine kinase activity compared to celecoxib.
Why the study?
Does celecoxib or meloxicam affect cardiovascular risk markers in patients with rheumatoid arthritis?
Cohort (n=48)
No
Does celecoxib or meloxicam affect cardiovascular risk markers in patients with rheumatoid arthritis?
Both celecoxib and meloxicam adversely affect lipid profiles in rheumatoid arthritis patients, but meloxicam may pose a greater cardiovascular risk by increasing serum creatine kinase and creatinine levels.
Answers are grounded in this paper and cite their sources.
Meloxicam-associated CK rise may signal higher CV risk in RA; hypothesis-generating and should not yet change practice.
Background: Prostaglandin G/H Synthases (Cyclooxygenases) are enzymes that catalyze the conversion of arachidonic acid to a series of compounds endingin prostaglandins, endogenous compounds triggering many biological & physiological events in many systems including circulatory & renal systems.The normal balance between Cox-1 derived thromboxane A2 (TXA2) which acts as a platelet activator enhancing thrombosis, & the antithrombotic cardioprotective effects of prostacyclin (PGI2) which is produced through Cox-2 activity. Thus inhibition of Cox-2 derived PGI2 will exaggerate the cardiovascular effects of TXA2. Cyclooxygenase - 2 (Cox-2) inhibitors have different odds on cardiovascular risk factors through selectivity to that enzymethat could play a role in their pharmacological action.Objective: Our study includes a comparison between the effects of the purely cox-2 selective inhibitor (Celecoxib), and the relatively Cox-2 selective inhibitor(Meloxicam) on some cardiovascular risk markers in patients suffering from rheumatoid arthritis.Materials &Methods: Thirty –six patients were selected as having rheumatoid arthritis (RA) with age range of 30-60 years (48±9.72), in addition to a group ofnormal subjects (12) were included as a control group Specific biochemical investigations based on measuring highly sensitive kit for serum C – reactiveprotein (hs-CRP), serum creatine kinase( CK), serum aspartate aminotransferase(AST), serum urea, serum creatinine, and serum lipid profile.The patients were treated with celecoxib 400mg/day or with meloxicam 15mg/day for 3 months period.Results: Both drugs were able to reduce (significantly) the highly sensitive Creactive protein and increase serum total cholesterol, Low Density Lipoprotein/High Density Lipoprotein (LDL/HDL) ratio as compared pretreatment values.Both drugs have nearly the same effects on renal function presented by decreasing glomerular filtration rate (GFR) as indicated by elevating serum urea levels.Conclusion: The selectivity of COX2 inhibition is not the major character that could be correlated with cardiovascular events related to their administration.Since, meloxicam could aggravate some cardiovascular risk factors more than celecoxib does, as presented a significant increment in serum CK activity.
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Hadi et al. (2010) conducted a cohort in Rheumatoid arthritis (n=48). Celecoxib vs. Meloxicam 15 mg/day was evaluated on Serum creatine kinase (CK) activity (p=<0.05). In patients with rheumatoid arthritis, both celecoxib and meloxicam altered lipid profiles and reduced C-reactive protein, but meloxicam significantly increased serum creatine kinase activity compared to celecoxib.
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