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Selective COX-2 inhibitors linked to risk of myocardial infarction


Researchers at University of Manchester, UK, evaluated the risk of myocardial infarction associated with the use of selective cyclooxygenase-2 ( COX-2 ) inhibitors ( coxibs ).

A systematic review and meta-analysis of randomised controlled trials ( RCT s) were performed.
Fifty-five trials ( 99 087 patients ) were included in the meta-analysis.

The overall pooled odds ratio ( OR ) for myocardial infarction risk for any coxib compared against placebo was 1.46.
Celecoxib ( Celebrex ), Rofecoxib ( Vioxx ), Etoricoxib ( Arcoxia ), Valdecoxib ( Bextra ) and Lumiracoxib ( Prexige ) were associated with higher myocardial infarction risks compared against placebo.

The pooled odds ratio for any coxib compared against other NSAIDs was 1.45.
Rofecoxib had a significantly higher risk of myocardial infarction than Naproxen ( OR: 5.39 ), and Valdecoxib had lower myocardial infarction risk than Diclofenac ( Voltaren ) ( OR: 0.14 ).

There were no significant differences identified in the risk of myocardial infarction from the available head-to-head comparisons of coxibs.

Coxibs were associated with increased risks of myocardial infarction when compared against placebo or non-selective NSAIDs. Differences in MI risk were also apparent between comparisons of individual NSAIDs.

Source: Pharmacoepidemiology and Drug Safety, 2007

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