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Independents' Day

NSAID risk same as cox-2s

High doses of ibuprofen and diclofenac carry the same cardiovascular risks as cox-2 inhibit-ors and should be subject to the same restrictions in use, a new study concludes.

The research, published in this week's BMJ, found both cox-2s and conventional NSAIDs modestly increased the risk of cardiovascular events, with 'no significant difference' between the two groups.

The study, which combined data on 138 randomised trials of cox-2s and NSAIDs, follows research reported in Pulse last month that also suggested risk did not differ significantly between the two groups of drugs.

Dr Colin Baigent, leader of the new study and reader in clinical epidemiology at the University of Oxford, said: 'Our meta-analysis includes all of the randomised trials and provides a much more reliable picture of the safety of cox-2s, and relative safety of NSAIDs.'

Dr Baigent added: 'We should treat both cox-2s and NSAIDs as valuable drugs, but be aware of the size of their risks. For people at increased risk of heart attacks, doctors may feel they should look to alternative forms of pain relief.'

Cox-2s as a group increased the incidence of myocardial infarction, stroke or vascular death by 42 per cent compared with placebo.

Overall, the risk with NSAIDs was not sigificantly different, but it appeared to vary between drugs. High-dose ibuprofen raised risk by 51 per cent and high-dose diclofenac by 63 per cent. But similar doses of naproxen did not increase risk.

An accompanying commentary in the BMJ urged doctors to 'broaden their approach to pain in older patients'.

Dr Jim Kennedy, RCGP prescribing spokesman, said: 'What it says is there are vascular risks with all high-dose NSAIDs and cox-2s. We know there are also GI risks and other adverse effects.'

Dr Iain Gilchrist, a GPSI in rheumatology in Hatfield Heath, Essex, said: 'When cox-2s were found to have some cardiovascular risk problems it was assumed, wrongly, that the original NSAIDs were free of that. It's become obvious that isn't the case.'

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