We appreciate the comments of our colleague, Dr. Finucane, and recognize how one could come to such a conclusion. Celecoxib's absence from the 2012 American Geriatric Society (AGS) Beers Criteria list of nonsteroidal anti-inflammatory drugs (NSAIDs) whose chronic use should be avoided should not be mistaken as an endorsement of celecoxib. The absence of any drug from the 2012 AGS Beers Criteria should not be taken as an endorsement or considered an alternative to those listed. The need for and desire to provide alternative treatments are recognized in the perspective in the same issue of the Journal as the updated criteria. Celecoxib and other NSAIDs are included as drugs to avoid in persons with heart failure or Stage 3 or 4 chronic kidney disease.
The panel's decision to exclude celecoxib was not based on the Celecoxib Long-term Arthritis Safety Study's findings (see evidence-based table at http://www.americangeriatrics.org/files/documents/beers/2012AGSBeersCriteria-Citations.pdf. Subsequent trials and a Cochrane review found a two times or greater risk of clinically important gastrointestinal complications with the nonselective NSAIDs than with the cyclooxygenase-2 inhibitor NSAIDs.[3-7]
Consistent with every drug listed in the 2012 AGS Beers Criteria, the prescribing of an NSAID to an older adult requires careful consideration of the risks and benefits and is ultimately a prescriber–patient decision.