Effect of dosage on coxib- or nonsteroidal antiinflammatory drug–associated cardiovascular risk? Comment on the article by Solomon et al


Effect of Dosage on Coxib- or Nonsteroidal Antiinflammatory Drug–Associated Cardiovascular Risk? Comment on the Article by Solomon et al

To the Editor:

Solomon and colleagues are to be congratulated on their elegant cohort study comparing cardiovascular risk in new users of selective cyclooxygenase 2 inhibitors (coxibs) and nonsteroidal antiinflammatory drugs (Solomon DH, Avorn J, Sturmer T, Glynn RJ, Mogun H, Schneeweiss S. Cardiovascular outcomes in new users of coxibs and nonsteroidal antiinflammatory drugs: high-risk subgroups and time course of risk. Arthritis Rheum 2006;54:1378–89). It provides new and important insights into the comparative cardiovascular risk associated with the use of these agents.

An important analysis, which I am sure the authors performed, appears to be missing from the report: the analysis of risk in patients receiving high-dose versus low-dose drug. The data were collected, but the results were only alluded to in the Discussion, in which the authors state that only a small minority of patients in the database used celecoxib at dosages ≥400 mg/day. For each of the studied drugs, I believe it is important to know how many patients were receiving a high or a low dose, and whether this affected their cardiovascular risk.

Maarten Boers MD, PhD*, * VU University Medical Center, Amsterdam, The Netherlands.