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Cox-2 risk 'overblown'

By Daniel Cressey

Conventional NSAIDs and most cox-2 inhibitors carry a 'minimal to non-existent' risk of heart attacks, a major new assessment of all available evidence concludes.

The systematic review of data on over a million patients found only rofecoxib and diclofenac raised risk significantly ­ by 61 and 42 per cent respectively.

The research could be the first step in rehabilitating the cox-2s after adverse publicity following the withdrawal of rofecoxib sent prescribing plummeting.

Dr Ernest Choy, researcher on the study and senior lecturer in the academic department of rheumatology, King's College London, said: 'The absolute risk is very small ­ we should measure that against the benefit the patient has in having a reasonable lifestyle.

'Unfortunately when the media get hold of things there is always a danger that the risks get overblown.'

Dr Choy's research, presented at the British Society for Rheumatology annual conference in Glasgow this week, analysed data on 1.23 million participants in case-control or cohort studies.

Overall, there was an apparent 14 per cent increase in risk of myocardial infarction among NSAID users, which fell short of statistical significance. Among patients on celecoxib, there was an apparent 17 per cent increase in risk, but this again failed to reach significance.

'In arthritis, the risk of MIs with conventional NSAIDs and most cox-2 drugs is minimal to non-existent,' the researchers concluded.

Dr Mayur Lakhani, chair of the RCGP, called for the drug safety bodies to examine the new evidence. 'GPs feel un-

certain about prescribing anti-inflammatories in general now. Anything that clarifies the situation would be welcome. The authorities need to consider this evidence.'

Professor Hugh McGavock, visiting professor of prescribing science at the University of Ulster and a former member of the Committee on Safety of Medicines, said: 'The original evidence is clear that although the risk is very small with cox-2s it is still measurable and significantly greater than the original NSAIDs.

'The question is balancing the risk versus benefits; as long as the GP has in mind the risk profile ­ which is high in NSAIDs.'

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