Non-steroidal anti-inflammatory drugs (NSAIDs) were differentiated from steroidal anti-inflammatory medicines to help clinicians who needed to use anti-inflammatory agents that were safer than steroids. With market entry of rofecoxib in 1999, NSAIDs were then further classified into traditional NSAIDs and cyclooxygenase (COX)-2 inhibitors (coxibs), the latter posing potentially fewer gastrointestinal risks. In 2005, rofecoxib was withdrawn from the market because of concerns about the risk of heart attack and stroke with long-term use, and clinical practice began focusing more on the cardiovascular versus gastrointestinal safety of coxibs. Since then, many coxibs have remained unapproved by the US FDA or have been removed from the market. This article explains how coxibs refocused attention on the cardiovascular safety of NSAIDs and the general implications of that. COX-2 activity/specificity is one factor associated with increased cardiovascular risks; however, these risks cannot be attributed to coxibs alone. The traditional NSAIDs (i.e., meloxicam, etodolac, and nabumetone) have significant COX-2 specificity, but naproxen and ibuprofen have less specificity. All NSAIDs, whether traditional or a coxib, pose some cardiovascular risks. It is possible that clinicians continue to focus more on decreasing the immediate gastric risks than preventing the later cardiovascular risks. The cardiovascular risks posed by NSAIDs should not be disregarded for the sake of achieving gastrointestinal benefits. Current recommendations suggest NSAIDs should be considered a single class of non-aspirin NSAIDs. Preferred NSAIDs are ibuprofen and naproxen. Coxibs are preferred in patients with low cardiovascular risk and high gastrointestinal risk who are intolerant to anti-dyspepsia therapy.
Extract The September ESHRE Journal Club discussed a paper from Lensen et al. (2021) about the prevalence and pattern of add-on use in ART. The paper was based on an online national survey in Australia for women having ART treatment over a 3-year period. Survey questions covered demographics, IVF history and the use of IVF add-ons. This survey showed that 82% of the 1590 eligible patients have used at least one add-on during treatment and usually at an additional cost (72% of cases). The majority of patients shared the decision of add-on use with their fertility specialist and placed a high level of importance on safety and efficacy based on scientific evidence. The study also highlighted a high proportion of patient regret (83%) after unsuccessful treatments and when the specialist had a larger contribution in the decision to use add-ons (75%). Due to large add-on utilization, it was interesting for Journal Club participants to discuss whether their use is supported by scientific evidence and how this evidence is disseminated. What is the regulatory framework around add-on use and what are patients' perspectives? The ESHRE Journal Club with 45 participants, experts Raj Mathur and Christos Venetis, as well as a representative from the patient association Fertility Europe, discussed the topic on Twitter; >800k impressions were recorded over the 24-h period.
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