CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
356
AFRICA
Benefit versus risk in the use of non-selective NSAIDs and selective COX-2 inhibitors
The use of COX-2 inhibitors (COXibs)
as therapy for both acute and chronic
musculoskeletal disease is well
established in South African therapeutic
guidelines. These agents need to be used
to support the objective of reducing
symptoms and attaining a low activity
status.
1,2
Celecoxib, the widely-used COX-2
inhibitor, has official indications for
symptomatic relief in rheumatoid
arthritis and osteoarthritis, and also
evidence of efficacy in acute low-back
pain,
3
acute ankle sprains,
4
acute
shoulder pain, and dysmenorrhoea.
5
A
recent
Cochrane
systemic review has
also shown the efficacy of celecoxib
therapy for acute post-operative pain.
6
While it is well accepted that
celecoxib is less likely to cause
gastrointestinal bleeds and symptoms
than non-selective traditional anti-
inflammatories, the difference in
cardiovascular safety is still of concern
to some cardiologists and physicians.
Prof Huang addressed the risk-benefit
profile of non-selective non-steroidal
anti-inflammatory drugs (nsNSAIDs)
in a series of symposia sponsored by
Pfizer, following on the FCPSA annual
congress held in Cape Town recently.
Referring to the Harvard-based study
conducted by Hermandez-Diaz and
co-workers,
7
Prof Huang noted that
smoking, diabetes and hypertension
cause many more cardiovascular-related
problems than either the non-aspirin
NSAIDs or the COXibs.
‘In Diaz’s systematic review of
the use of NSAIDS and the risk of
acute myocardial infarction (MI), there
was an increased MI risk observed
for diclofenac and rofecoxib. The
relative risk ratio (RRR) however for
celecoxib (0.96) was very similar to
that of naproxen (0.98), which has been
regarded as the safest NSAID to use in
at-risk cardiovascular patients.’
‘The available evidence supports the
view that celecoxib and nsNSAIDs,
used with or without proton pump
inhibitors, are equally effective. The
risks related to the cardiovascular and
renal vascular systems are similar’, he
commented.
Dr Huang noted that to minimise
any potential risks, normal good clinical
practice should be in place when either
celecoxib or the NSAIDS are used.
‘These agents should be used at the
lowest effective dosage, after careful
evaluation of the gastrointestinal,
cardiovascular and renal risks of the
individual patient’, he concluded.
Julia Aalbers
1.
South African Acute Pain Guidelines.
S
Afr J Anaesthesia Analgesia
2009;
15
(6):
1–120.
2.
3.
Petri M, Hufman SL, Waser G,
et al
.
Celecoxib effectively treats patients
with acute shoulder tendinitis/bursitis.
J
Rheumatol
2004;
31
(8): 1614–1620.
4.
Cardenas-Estrade E,
et al.
Efficacy and
safety of celecoxib in the treatment of
acute pain due to ankle sprain in a Latin
American and Middle Eastern Population
.
J Int Med Res
2009;
37
(6): 1937–1951.
5.
Daniels S,
et al.
Celecoxib in the treat-
ment of primary dysmenorrhea.
Clin Ther
209;
31
(6): 1192–1208.
6.
Derry S, Moore RA. Single dose oral
celecoxib for acute postoperative pain in
adults.
Cochrane Database Syst Rev
2010;
14(3): CD004233.
7.
Hermandez-Diaz S,
et al
. Non-steroidal
anti-inflammatory drugs and the risk of
acute myocardial infarction.
Basic Clin
Pharmecol Toxicol
2006;
98
(3): 266–274.
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17-22 FEBRUARY 2013
CAPE TOWN, SOUTH AFRICA
6
th
Paediatric Cardiology & Cardiac Surgery
SOUTHAFRICAN
HEARTASSOCIATION
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