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Does Celecoxib Pose Greater Cardiovascular Risks Than NSAIDs?

; Atlanta Vol. 36, Iss. 9,  (Sep 2017).

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SOURCE : MacDonald TM, Hawkey CJ, Ford I, et al. Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib: The Standard care vs. Celecoxib Outcome Trial (SCOT). Eur Heart J 2017;38:1843-1850.

COX-2 inhibitors such as celecoxib have a lower risk of bleeding events than nonsteroidal anti-inflammatory drugs (NSAIDs) but have been associated with higher risks of cardiovascular (CV) events.

However, celecoxib is more potent for relieving symptoms in patients with arthritis. Investigators from Europe conducted the Standard Care vs. Celecoxib Outcome Trial, a prospective, randomized, open-label, blinded outcome evaluation study designed to compare CV and gastrointestinal (GI) safety of continuing NSAIDs compared to switching to celecoxib in patients with osteoarthritis or rheumatoid arthritis.

The patients were > 60 years of age and free from significant CV disease. The primary endpoint was the composite of acute coronary syndrome, stroke, or CV death. Between 2008 and 2013, 7,297 patients across nine trial centers in three countries and 706 primary care practices were randomized and followed for a median of three years. Osteoarthritis was present in 94%. About 70% were taking either diclofenac or ibuprofen. The primary endpoint occurred in 278 patients (4%): 125 on celecoxib and 124 on NSAIDs, which was statistically non-inferior for celecoxib CV outcomes. More serious GI adverse events were reported on NSAIDs (1.8 vs. 1.0%; P = 0.007), but more patients on celecoxib withdrew from treatment (51% vs. 30%; P < 0.0001).

The most common reason for withdrawal from celecoxib treatment was lack of efficiency (23%). The mortality rate was not significantly different between the two therapies (35 celecoxib patients vs. 41 NSAID patients).

The authors concluded that in patients > 60 years of age who were free from CV disease and taking NSAIDs for arthritis, there was no advantage in switching to celecoxib.