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Analgesics for Osteoarthritis—An Update

Slide: 17 of 32

Comparative Adverse Effects of Oral Agents: CV Effects

Celecoxib was associated with an increased risk of cardiovascular (CV) adverse effects (CV death, myocardial infarction, stroke, heart failure, or thromboembolic events) relative to placebo in systematic reviews of randomized controlled trials. One additional CV event occurred for about every 270 patients treated for 1 year with celecoxib when compared with placebo. Systematic reviews found no clear difference between celecoxib and the nonselective NSAIDs ibuprofen or diclofenac in risk of CV events.
Strength of evidence: Moderate

The nonselective NSAIDs ibuprofen and diclofenac, but not naproxen, were associated with an increased risk of heart attack relative to placebo. In two systematic reviews that included indirect analysis of randomized trials, naproxen was the only nonselective NSAID associated with neutral CV risk relative to placebo (RR 0.92, 95% CI 0.67 to 1.3 and RR 1.2, 95% CI 0.78 to 1.9, respectively).
Strength of evidence: Moderate 

All NSAIDs had deleterious effects on blood pressure, edema, and kidney function. There were no consistent clinically relevant differences between celecoxib, partially selective NSAIDs, and nonselective NSAIDs in the risk of hypertension, heart failure, or impaired kidney function.
Strength of evidence: Moderate