Análisis y evaluación del riesgo cardiovascular y gastrointestinal de los antiinflamatorios no esteroideos inhibidores selectivos y no selectivos de ciclooxigenasa / Analysis and evaluation of cardiovascular and gastrointestinal risk of nonsteroidal anti-inflammatory drugs selective and non-selective cyclooxygenase inhibitors

RESUMEN

Objetivos: revisar la evidencia publicada sobre el uso de AINE (coxibs y clásicos) y evaluar el riesgo cardiovascular (RCV) y gastrointestinal (RGI) asociado. Material y métodos: fueron seleccionados los estudios de cohorte y caso-control que mostraban el RCV o RGI de los AINE versus no expuestos. Se calculó el RR ponderado y el intervalo de confianza 95% para todos los AINE conjuntamente y de forma individual. Resultados: se observó un RCV significativo tanto con coxibs [RR= 1.24 (1.19-1.31)] como con AINE clásicos [RR= 1.18 (1.13-1.24)]. Para los coxibs sería elevado incluso a dosis bajas y en sujetos con RCV basal bajo. Por fármaco individual, rofecoxib [RR= 1.41 (1.33-1.50)] junto con diclofenaco [RR= 1.36 (1.27-1.47)] y etoricoxib [RR= 1.26 (1.08-1.48)] son los AINE con mayor RCV. El metaanálisis sobre el RGI mostró riesgo con los coxibs [RR 1.64 (95% CI 1.44-1.86)]. Por fármaco individual, etoricoxib [RR 4.48 (95% CI 2.98-6.75)] presentó mayor riesgo seguido de rofecoxib [RR 2.02 (95% CI 1.56-2.61)] y celecoxib [RR 1.62 (95% CI 1.46-1.78)]. El riesgo también fue elevado para dosis bajas y edad <65 años. Conclusión: según nuestro estudio, el uso de AINE (coxibs y clásicos) está relacionado con un incremento similar del RCV, incluso a dosis bajas y en pacientes con un RCV bajo-medio. Por otro lado, el uso de coxibs se relacionaría con un incremento del RGI, siendo elevado incluso para dosis bajas y edad <65 años. El riesgo para etoricoxib podría ser superior que para celecoxib y rofecoxib.(AU)

ABSTRACT

Introduction: the aim of this study is to review the current evidence on the clinical use of NSAIDs, coxibs and nonselective, and to evaluate its cardiovascular (CVR) and gastrointestinal risk (GIR) by means of a meta-analytic procedure. Materials and methods: cohort and case-control studies showing CVR and GIR associated with NSAIDs versus no treatment were selected. We estimated the pooled RR and the 95% confidence interval (CI) for all NSAIDs as a whole and individually. Results: both coxibs (RR, 1.22 [95%CI, 1.17-1.28]) and nonselective NSAIDs (RR 1.18 [95%CI, 1.12-1.24]) were associated with an increased CVR. The coxibs CVR remained even for low-dose and low-baseline CVR subgroups. Analysis by drug disclosed that rofecoxib (RR 1.39 [95%CI, 1.31- 1.47]), along with diclofenac (RR, 1.34 [95%CI, 1.26-1.42]) and etoricoxib (RR 1.27 [95%CI, 1.12-1.43]) were the NSAIDs associated with the highest CVR. Gastrointestinal risk meta-analysis showed that coxibs were associated with a GIR increment [RR1.64 (95% CI 1.44-1.86)]. Analysis by drug disclosed that etoricoxib [RR 4.48 (95% CI 2.98-6.75)]presented the highest GIR followed by rofecoxib [RR 2.02 (95% CI 1.56-2.61)] and celecoxib [RR1.62 (95% CI 1.46-1.78)]. GIR was also high for <65 year-old and low-dose coxibs subgroups. Conclusion: according to our study the use of NSAIDs (coxibs and nonselective) are associated with a similar CVR increment, even for low-dose and low-baseline CVR subgroups. On the other hand, the use of coxibs is associated with a GIR increased, which would be high even for low-dose coxibs and <65-year-old subgroups. The risk would be higher for etoricoxib than for celecoxib and rofecoxib.