Cardiac toxicity of coxibs: mechanisms of development and their prevention

Authors

  • O O Yakovleva National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • A O Zhamba National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • I O Doroshkevych National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • T K Vitruk National Pirogov Memorial Medical University, Vinnytsia, Ukraine

DOI:

https://doi.org/10.31636/pmjua.v3i3.3

Keywords:

NSAIDs, selectivity, coxibs, cardiovascular toxicity, evidence-based medicine

Abstract

Development of highly selective COX-2 inhibitors – coxibs has proved a decreased risk of gastrointestinal toxicity, which was typical for non-selective NSAIDS, according to the evidence-based medicine. But such situation caused an imbalance in the impact on the synthesis of arachidonic acid metabolites: inhibition of COX-2 vasodilatatory prostacyclins and activation of thromboxane synthesis by platelets, which is accompanied by the increase in the frequency of thrombotic complications – myocardial infarctions and strokes. Some meta-analyses have proved this association: the higher is COX-2 inhibitors selectivity – the higher are CV-risks and cardiovascular toxicity of coxibs. Discontinuation or limitation of indications of coxibs, assessment of risk / benefit ratio is recommended in the conditions of comorbidity of CVS pathology, pain syndromes in rheumatology. Drugs of choice are moderately selective COX-2 inhibitors = meloxicam and nimesulide.

Downloads

Download data is not yet available.

References

Side effects of non-steroidal anti-inflammatory drugs. Consilium Medicum [Internet]. MediaMedica; 2017;19(12):94–9. Available from: https://doi.org/10.26442/2075-1753_19.12.94-99

Karpenko EA. Nesteroidnye protivovospalitelnye preparaty i arterialnaya gipertenziya – problema sovremennoj kardiologii ( Non-steroidal anti-inflammatory drugs and arterial hypertension is a problem of modern cardiology). Ukrayinskij naukovo-medichnij molodizhnij zhurnal. 2014;1(79):160–3. (In Russian)

Koksiby: sushestvuyut li preimushestva po sravneniyu s tradicionnymi neselektivnymi NPVP v lechenii posleoperacionnoj boli? (Coxibs: are there advantages over traditional non-selective NSAIDs in the treatment of postoperative pain?). Zdorov’ya Ukrayini. 2014;4:27–9. (In Russian)

Satybaldyev AM. Chto bezopasnee dlya zheludochno-kishechnogo trakta –koksiby ili meloksikam? (What is safer for the gastrointestinal tract - coxibs or meloxicam?). Sovremennaya revmatologiya. 2017;11(1):72–8. (In Ukrainian)

Shostak NA. Nesteroidnye protivovospalitelnye preparaty – sovremennye aspekty ih primeneniya (Nonsteroidal anti-inflammatory drugs - modern aspects of their use). Klinicist. 2013;3(4):53–61. (In Russian)

Back M, Yin L, Ingelsson E. Cyclooxygenase-2 inhibitors and cardiovascular risk in a nation-wide cohort study after the withdrawal of rofecoxib. European Heart Journal [Internet]. Oxford University Press (OUP); 2011 Nov 21;33(15):1928–33. Available from: https://doi.org/10.1093/eurheartj/ehr421

Bavry AA, Khaliq A, Gong Y, Handberg EM, Cooper-DeHoff RM, Pepine CJ. Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease. The American Journal of Medicine [Internet]. Elsevier BV; 2011 Jul;124(7):614–20. Available from: https://doi.org/10.1016/j.amjmed.2011.02.025

BEXTRA: valdecoxib tablets. Anaviable at www.pfizer.com/download/uspi_bextra.pdf

Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. The Lancet [Internet]. Elsevier BV; 2013 Aug;382(9894):769–79. Available from: https://doi.org/10.1016/s0140-6736(13)60900-9

Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FKL, et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. Circulation [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Oct 28;118(18):1894–909. Available from: https://doi.org/10.1161/circulationaha.108.191087

Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B, et al. Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2000 Nov 23;343(21):1520–8. Available from: https://doi.org/10.1056/nejm200011233432103

Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al. Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention Trial. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2005 Mar 17;352(11):1092–102. Available from: https://doi.org/10.1056/nejmoa050493

Caldwell B. Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. Journal of the Royal Society of Medicine [Internet]. SAGE Publications; 2006 Mar 1;99(3):132–40. Available from: https://doi.org/10.1258/jrsm.99.3.132

Cannon CP, Curtis SP, FitzGerald GA, Krum H, Kaur A, Bolognese JA, et al. Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. The Lancet [Internet]. Elsevier BV; 2006 Nov;368(9549):1771–81. Available from: https://doi.org/10.1016/s0140-6736(06)69666-9

Capone ML, Sciulli MG, Tacconelli S, Grana M, Ricciotti E, Renda G, et al. Pharmacodynamic interaction of naproxen with low-dose aspirin in healthy subjects. Journal of the American College of Cardiology [Internet]. Elsevier BV; 2005 Apr;45(8):1295–301. Available from: https://doi.org/10.1016/j.jacc.2005.01.045

Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2001 Dec 20;345(25):1809–17. Available from: https://doi.org/10.1056/nejmoa003199

Chen Y, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, et al. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation. Health Technology Assessment [Internet]. National Institute for Health Research; 2008 Apr;12(11). Available from: https://doi.org/10.3310/hta12110

De Leest HTJI, Steen KSS, Lems WF, Bijlsma JWJ, van de Laar MAFJ, Huisman AM, et al. Eradication of Helicobacter pylori Does Not Reduce the Incidence of Gastroduodenal Ulcers in Patients on Long-term NSAID Treatment: Double-Blind, Randomized, Placebo-Controlled Trial. Helicobacter [Internet]. Wiley; 2007 Oct;12(5):477–85. Available from: https://doi.org/10.1111/j.1523-5378.2007.00543.x

Emery P, Zeidler H, Kvien TK, Guslandi M, Naudin R, Stead H, et al. Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: randomised double-blind comparison. The Lancet [Internet]. Elsevier BV; 1999 Dec;354(9196):2106–11. Available from: https://doi.org/10.1016/s0140-6736(99)02332-6

FitzGerald GA, Patrono C. The Coxibs, Selective Inhibitors of Cyclooxygenase-2. Wood AJJ, editor. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2001 Aug 9;345(6):433–42. Available from: https://doi.org/10.1056/nejm200108093450607

Fosbøl E, Gislason G, Jacobsen S, Folke F, Hansen M, Schramm T, et al. Risk of Myocardial Infarction and Death Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Among Healthy Individuals: A Nationwide Cohort Study. Clinical Pharmacology & Therapeutics [Internet]. Springer Nature; 2008 Nov 5;85(2):190–7. Available from: https://doi.org/10.1038/clpt.2008.204

GOLDSTEIN J, SILVERSTEIN F, AGRAWAL N, HUBBARD R, KAISER J, MAURATH C, et al. Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor. The American Journal of Gastroenterology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Jul;95(7):1681–90. Available from: https://doi.org/10.1016/s0002-9270(00)00986-2

Gottlieb S. Warnings issued over COX 2 inhibitors in US and UK. BMJ [Internet]. BMJ; 2004 Dec 30;330(7481):9.4. Available from: https://doi.org/10.1136/bmj.330.7481.9-c

Hunt R. The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events. The American Journal of Gastroenterology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Aug;98(8):1725–33. Available from: https://doi.org/10.1016/s0002-9270(03)00449-0

Jüni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. The Lancet [Internet]. Elsevier BV; 2004 Dec;364(9450):2021–9. Available from: https://doi.org/10.1016/s0140-6736(04)17514-4

Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP. Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. The Lancet [Internet]. Elsevier BV; 2007 Feb;369(9560):465–73. Available from: https://doi.org/10.1016/s0140-6736(07)60234-7

Lazzaroni M, Bianchi Porro G. Nonsteroidal anti-inflammatory drug gastropathy and helicobacter pylori: the search for an improbable consensus. The American Journal of Medicine [Internet]. Elsevier BV; 2001 Jan;110(1):S50–S54. Available from: https://doi.org/10.1016/s0002-9343(00)00636-7

Lee TA, Bartle B, Weiss KB. Impact of NSAIDS on Mortality and the Effect of Preexisting Coronary Artery Disease in US Veterans. The American Journal of Medicine [Internet]. Elsevier BV; 2007 Jan;120(1):98.e9–98.e16. Available from: https://doi.org/10.1016/j.amjmed.2006.03.003

McGettigan P, Henry D. Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies. Strom BL, editor. PLoS Medicine [Internet]. Public Library of Science (PLoS); 2011 Sep 27;8(9):e1001098. Available from: https://doi.org/10.1371/journal.pmed.1001098

Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL, et al. Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac Surgery. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2005 Mar 17;352(11):1081–91. Available from: https://doi.org/10.1056/nejmoa050330

Ott E, Nussmeier NA, Duke PC, Feneck RO, Alston RP, Snabes MC, et al. Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. The Journal of Thoracic and Cardiovascular Surgery [Internet]. Elsevier BV; 2003 Jun;125(6):1481–92. Available from: https://doi.org/10.1016/s0022-5223(03)00125-9

Patrono C, Baigent C. Low-Dose Aspirin, Coxibs, and other NSAIDS: A Clinical Mosaic Emerges. Molecular Interventions [Internet]. CLOCKSS Archive; 2009 Feb 1;9(1):31–9. Available from: https://doi.org/10.1124/mi.9.1.8

Ramey DR, Watson DJ, Yu C, Bolognese JA, Curtis SP, Reicin AS. The incidence of upper gastrointestinal adverse events in clinical trials of etoricoxib vs. non-selective NSAIDs: an updated combined analysis. Current Medical Research and Opinion [Internet]. Informa Healthcare; 2005 Apr 13;21(5):715–22. Available from: https://doi.org/10.1185/030079905x43686

Ray WA, Griffin MR, Stein CM. Cardiovascular Toxicity of Valdecoxib. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2004 Dec 23;351(26):2767–2767. Available from: https://doi.org/10.1056/nejmc045711

Ray WA, Stein CM, Daugherty JR, Hall K, Arbogast PG, Griffin MR. COX-2 selective non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease. The Lancet [Internet]. Elsevier BV; 2002 Oct;360(9339):1071–3. Available from: https://doi.org/10.1016/s0140-6736(02)11131-7

Rostom A, Muir K, Dubé C, Jolicoeur E, Boucher M, Joyce J, et al. Gastrointestinal Safety of Cyclooxygenase-2 Inhibitors: A Cochrane Collaboration Systematic Review. Clinical Gastroenterology and Hepatology [Internet]. Elsevier BV; 2007 Jul;5(7):818–828.e5. Available from: https://doi.org/10.1016/j.cgh.2007.03.011

Sawitzke AD, Shi H, Finco MF, Dunlop DD, Harris CL, Singer NG, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Annals of the Rheumatic Diseases [Internet]. BMJ; 2010 Jun 4;69(8):1459–64. Available from: https://doi.org/10.1136/ard.2009.120469

Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, et al. Gastrointestinal Toxicity With Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis. JAMA [Internet]. American Medical Association (AMA); 2000 Sep 13;284(10):1247. Available from: https://doi.org/10.1001/jama.284.10.1247

Singh G, Fort JG, Goldstein JL, Levy RA, Hanrahan PS, Bello AE, et al. Celecoxib Versus Naproxen and Diclofenac in Osteoarthritis Patients: SUCCESS-I Study. The American Journal of Medicine [Internet]. Elsevier BV; 2006 Mar;119(3):255–66. Available from: https://doi.org/10.1016/j.amjmed.2005.09.054

Singh G, Miller JD, Lee FH, Pettitt D, Russell MW. Prevalence of cardiovascular disease risk factors among US adults with self-reported osteoarthritis: data from the Third National Health and Nutrition Examination Survey. Am J Manag Care. 2002 Oct;8(15 Suppl):S383-91.

Singh G, Mithal A, Triadafilopoulos G. Age-Adjusted Hospitalization Rates for Complicated Gastric and Duodenal Ulcers in the US: Have COX-2 Specific Inhibitors and PPIs Made Any Difference? Gastrointestinal Endoscopy [Internet]. Elsevier BV; 2004 Apr;59(5):P162. Available from: https://doi.org/10.1016/s0016-5107(04)00768-0

Smale S, Tibble J, Sigthorsson G, Bjarnason I. Epidemiology and differential diagnosis of NSAID-induced injury to the mucosa of the small intestine. Best Practice & Research Clinical Gastroenterology [Internet]. Elsevier BV; 2001 Oct;15(5):723–38. Available from: https://doi.org/10.1053/bega.2001.0231

Solomon SD, McMurray JJV, Pfeffer MA, Wittes J, Fowler R, Finn P, et al. Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2005 Mar 17;352(11):1071–80. Available from: https://doi.org/10.1056/nejmoa050405

Solomon SD, Wittes J, Finn PV, Fowler R, Viner J, Bertagnolli MM, et al. Cardiovascular Risk of Celecoxib in 6 Randomized Placebo-Controlled Trials. Circulation [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Apr 22;117(16):2104–13. Available from: https://doi.org/10.1161/circulationaha.108.764530

Schnitzer TJ, Burmester GR, Mysler E, Hochberg MC, Doherty M, Ehrsam E, et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. The Lancet [Internet]. Elsevier BV; 2004 Aug;364(9435):665–74. Available from: https://doi.org/10.1016/s0140-6736(04)16893-1

Rofecoxib, Merck, and the FDA. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2005 Mar 17;352(11):1163–1163. Available from: https://doi.org/10.1056/nejm200503173521132

Topol EJ. Arthritis Medicines and Cardiovascular Events—“House of Coxibs.”JAMA [Internet]. American Medical Association (AMA); 2005 Jan 19;293(3):366. Available from: https://doi.org/10.1001/jama.293.3.366

White WB, West CR, Borer JS, Gorelick PB, Lavange L, Pan SX, et al. Risk of Cardiovascular Events in Patients Receiving Celecoxib: A Meta-Analysis of Randomized Clinical Trials. The American Journal of Cardiology [Internet]. Elsevier BV; 2007 Jan;99(1):91–8. Available from: https://doi.org/10.1016/j.amjcard.2006.07.069

Yang M, Wang H-T, Zhao M, Meng W-B, Ou J-Q, He J-H, et al. Network Meta-Analysis Comparing Relatively Selective COX-2 Inhibitors Versus Coxibs for the Prevention of NSAID-Induced Gastrointestinal Injury. Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2015 Oct;94(40):e1592. Available from: https://doi.org/10.1097/md.0000000000001592

Cardiac toxicity of coxibs: mechanisms of development and their prevention

Published

2018-11-23

How to Cite

1.
Yakovleva OO, Zhamba AO, Doroshkevych IO, Vitruk TK. Cardiac toxicity of coxibs: mechanisms of development and their prevention. PMJUA [Internet]. 2018 Nov. 23 [cited 2024 Mar. 29];3(3):27-32. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/154

Similar Articles

1 2 3 4 5 6 7 8 > >> 

You may also start an advanced similarity search for this article.