Risk of myocardial infarction associated with selective COX-2 inhibitors: Meta-analysis of randomised controlled trials†
Article first published online: 25 APR 2007
Copyright © 2007 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 16, Issue 7, pages 762–772, July 2007
How to Cite
Chen, L.-C. and Ashcroft, D. M. (2007), Risk of myocardial infarction associated with selective COX-2 inhibitors: Meta-analysis of randomised controlled trials. Pharmacoepidem. Drug Safe., 16: 762–772. doi: 10.1002/pds.1409
No conflict of interest was declared.
- Issue published online: 28 JUN 2007
- Article first published online: 25 APR 2007
- Manuscript Accepted: 14 MAR 2007
- Manuscript Received: 12 MAR 2007
- COX-2 inhibitor;
- systematic review;
- myocardial infarction
To evaluate the risk of myocardial infarction (MI) associated with the use of selective cyclooxygenase-2 (COX-2) inhibitors (coxibs).
Systematic review and meta-analysis of randomised controlled trials (RCTs) using a fixed-effect model to estimate the odds ratios (ORs) for risk of MI associated with coxibs compared against placebo, non-steroidal anti-inflammatory drugs (NSAIDs) and other coxibs.
Fifty-five trials (99 087 patients) were included in the meta-analysis. The overall pooled OR for MI risk for any coxib compared against placebo was 1.46 (95%CI: 1.02, 2.09). We found celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib were associated with higher MI risks compared against placebo. The pooled OR for any coxib compared against other NSAIDs was 1.45 (95%CI: 1.09, 1.93). Rofecoxib had a significantly higher risk of MI than naproxen (OR: 5.39; 95%: 2.08, 14.02) and valdecoxib had lower MI risk than diclofenac (OR: 0.14, 95%CI: 0.03, 0.73). There were no significant differences identified in the risk of MI from the available head-to-head comparisons of coxibs.
Coxibs were associated with increased risks of MI when compared against placebo or non-selective NSAIDs. Differences in MI risk were also apparent between comparisons of individual NSAIDs. Future work should consider using individual patient data (IPD) meta-analysis to explore differences in MI risk between different subgroups of patients. Copyright © 2007 John Wiley & Sons, Ltd.