Cardiovascular safety of celecoxib in rheumatoid arthritis and osteoarthritis patients: A systematic review and meta-analysis

Abstract

Objective To assess the cardiovascular safety of celecoxib compared to non-selective non-steroid anti-inflammatory drugs or placebo. Methods We included randomized controlled trials of oral celecoxib compared with a non-selective NSAID or placebo in rheumatoid arthritis and osteoarthritis patients. We conducted searches in EMBASE, Cochrane CENTRAL, MEDLINE, China National Knowledge Infrastructure, VIP, Wanfang, and Chinese Biomedical Literature Database. Study selection and data extraction were done by two authors independently. The risk of bias was assessed using Cochrane’s risk-of-bias Tool for Randomized Trials. The effect size was presented as a risk ratio with their 95% confidence interval. Results Until July 22nd, 2021, our search identified 6279 records from which, after exclusions, 21 trials were included in the meta-analysis. The overall pooled risk ratio for Antiplatelet Trialists Collaboration cardiovascular events for celecoxib compared with any non-selective non-steroid anti-inflammatory drugs was 0.89 (95% confidence interval: 0.80–1.00). The pooled risk ratio for all-cause mortality for celecoxib compared with non-selective non-steroid anti-inflammatory drugs was 0.81 (95% confidence interval: 0.66–0.98). The cardiovascular mortality rate of celecoxib was lower than non-selective non-steroid anti-inflammatory drugs (risk ratio: 0.75, 95% confidence interval: 0.57–0.99). There was no significant difference between celecoxib and non-selective non-steroid anti-inflammatory drugs or placebo in the risk of other cardiovascular events. Conclusion Celecoxib is relatively safe in rheumatoid arthritis and osteoarthritis patients, independent of dose or duration. But it remains uncertain whether this would remain the same in patients treated with aspirin and patients with established cardiovascular diseases.

Gastroprotective effects of Taraxacum officinale (Dandelion) extract indomethacin-induced gastric ulcer model

“…In these cases, the human body produces too much prostaglandin, causing inflammation. Selective COX-2 inhibitors act by preventing this inflammation [33,34]. However, selective COX-2 inhibitors also prevent the production of beneficial prostaglandins, which are responsible for the prevention of gastric ulcer formation.…”

Comparison of cardiorenal safety of nonsteroidal anti-inflammatory drugs in the treatment of arthritis: a network meta-analysis

“…In the treatment of patients with arthritis, celecoxib is not the safest drug as it relates to the risk of adverse events of hypertension, edema, and cardiovascular and renal outcomes, but it is safer than rofecoxib, naproxen, ibuprofen, and etoricoxib ( 45 , 46 ). In 2005, Moore et al ( 47 ) reported that edema, heart failure, and death occurred at a lower rate in a celecoxib group than in the other NSAIDs groups, which is consistent with some of our conclusions.…”

Cardiovascular Manifestations in Rheumatoid Arthritis

“…62 The Celecoxib Long-term Arthritis Safety Study (CLASS) revealed no difference in the incidence of myocardial infarction or stroke between celecoxib and nonselective NSAID, except that celecoxib caused less number of sudden cardiac deaths than diclofenac. 61,63 Celecoxib was also associated with a similar or lower incidence of hypertension than NSAIDs. 63 The study also did not support the hypothesis that COX2 inhibitors increase the risk of CV thromboembolic events.…”

“…This increase in risk seems to persist for about 1 year after 3 years of treatment. 59 In a meta-analysis by Cheng et al, 61 the authors revealed that a different COX-2 inhibitor, celecoxib, did not appear to increase cardiovascular events when compared with placebo. In addition, there was a slightly decreased risk of all-cause and cardiovascular mortality compared with nonselective NSAIDs, which may prove it safe when used in RA.…”