Non-steroidal anti-inflammatory drugs and risk of cerebrovascular events in patients with osteoarthritis: a nested case–control study

Lapi, Francesco; Piccinni, Carlo; Simonetti, Monica; Levi, Miriam; Aprile, Pierangelo Lora; Cricelli, Iacopo; Cricelli, Claudio; Fanelli, Andrea

doi:10.1007/s11739-015-1288-3

Cited by 18 publications

(21 citation statements)

References 44 publications

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“…Eight of these studies were case-control design studies [18][19][20][21][22][23][24]28], and 5 were cohort studies [18,19,24,26,27]. The date of the publication of the 13 studies was 1999 [20] to 2017 [17].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The date of the publication of the 13 studies was 1999 [20] to 2017 [17]. Five studies were conducted in Europe [20,24,26,27], 4 in Asia [17,[21][22][23], 3 in Australia [20,25,28], and 1 in North America [29]. The number of participants ranged from 134 to 4,354, and the total number of participants was 1,839,462.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…To assess whether a single study had a substantial influence on the main results, we excluded each study consecutively and then evaluated its effect on the summary [18,19,[22][23][24]. Two studies estimated NSAIDs according to plasma half-life < 12 and > 12 h and the overall pooled RR 1.24 (95% CI 1.009-1.547, I 2 = 0.00, Q = 0.248) and RR 0.85 (95% CI 0.512-1.431, I 2 = 0.00, Q = 0.08) respectively [18,24].…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…Two studies estimated NSAIDs according to plasma half-life < 12 and > 12 h and the overall pooled RR 1.24 (95% CI 1.009-1.547, I 2 = 0.00, Q = 0.248) and RR 0.85 (95% CI 0.512-1.431, I 2 = 0.00, Q = 0.08) respectively [18,24]. Eight studies had ≤5 years' follow-up period and the risk of hemorrhagic stroke with NSAIDs was RR 1.17 (95% CI 0.911-1.527, I 2 = 92.816, Q = 0.97.436).…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies

et al. 2018

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Background and Aim: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common pain relief medications, but the risk of hemorrhagic stroke in patients taking these medications is unclear. In this study, our aim was to systematically review, synthesize, and critique the epidemiological studies that evaluate the association between NSAIDs and hemorrhagic stroke risk. We therefore assessed the current state of knowledge, filling the gaps in our existing concern, and make a recommendation for future research. Methods: We searched for articles in PubMed, EMBASE, Scopus, and Web of Science between January 1, 1990, and July 30, 2017, which reported on the association between the use of NSAIDs and hemorrhagic stroke. The search was limited to studies published in English. The quality of the included studies was assessed in accordance with the Cochrane guidelines and the Newcastle-Ottawa criteria. Summary risk ratios (RRs) with 95% CI were pooled using a random-effects model. Subgroup and sensitivity analyses were also conducted. Results: We selected 15 out of the 785 unique abstracts for full-text review using our selection criteria, and 13 out of these 15 studies met all of our inclusion criteria. The overall pooled RR of hemorrhagic stroke was 1.332 (95% CI 1.105–1.605, p = 0.003) for the random effect model. In the subgroup analysis, a significant risk was observed among meloxicam, diclofenac, and indomethacin users (RR 1.48; 95% CI 1.149–1.912, RR 1.392; 95% CI 1.107–1.751, and RR 1.363; 95% CI 1.088–1.706). In addition, a greater risk was found in studies from Asia (RR 1.490, 95% CI 1.226–1.811) followed by Europe (RR 1.393, 95% CI 1.104–1.757) and Australia (RR 1.361, 95% CI 0.755–2.452). Conclusion: Our results indicated that the use of NSAIDs is significantly associated with a higher risk of developing hemorrhagic stroke. These results should be interpreted with caution because they may be confounded owing to the observational design of the individual studies. Nevertheless, we recommend that NSAIDs should be used judiciously, and their efficacy and safety should be monitored proactively.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

See 2 more Smart Citations

Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies

et al. 2018

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“…Agents used for the management of pain and inflammation, or as preoperative regimens in OA patients, may cause undesired side effects [124,125,126]. Hopefully, miRNA-based strategies hold promise for OA therapeutics [127], and could be used as an alternative, and perhaps safer, treatment option.…”

Section: Mirna-dependent Pathways As Therapeutic Targets In Oa Andmentioning

confidence: 99%

The Role of miRNAs in Common Inflammatory Arthropathies: Osteoarthritis and Gouty Arthritis

2016

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MicroRNAs (miRNAs) are small, non-coding RNA species that are highly evolutionarily conserved, from higher invertebrates to man. Up to 1000 miRNAs have been identified in human cells thus far, where they are key regulators of the expression of numerous targets at the post-transcriptional level. They are implicated in various processes, including cell differentiation, metabolism, and inflammation. An expanding list of miRNAs is known to be involved in the pathogenesis of common, non-autoimmune inflammatory diseases. Interestingly, osteoarthritis (OA) is now being conceptualized as a metabolic disease, as there is a correlation among hyperuricemia and metabolic syndrome (MetS). Experimental evidence suggests that metabolic deregulation is a commonality between these different pathological entities, and that miRNAs are key players in the modulation of metabolic routes. In light of these findings, this review discusses the role of miRNAs in OA and gouty arthritis, as well as the possible therapeutic targetability of miRNAs in these diseases.

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Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

Arias

González

Fadrique

et al. 2018

The Journal of Clinical Pharma

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The purpose of this study was to review the published evidence on the clinical use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to assess the cardiovascular risk (CVR) of cyclooxygenase-2 inhibitors (coxibs), excluding aspirin, by means of a meta-analytic procedure. A search was conducted on MEDLINE and EMBASE databases between October 1999 and June 2018. Cohort and case-control studies showing CVR as relative risk (RR), odds ratio, hazard ratio, or incidence rate ratio 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. Eighty-seven studies met the inclusion criteria. Overall, NSAIDs were found to be associated with a statistically significantly increased CVR (RR, 1.24 [95%CI, 1.19-1.28]). The risk was slightly higher for coxibs (RR, 1.22 [95%CI, 1.17-1.28]) as compared with nonselective NSAIDs (RR, 1.18 [95%CI, 1.12-1.24]). Data analysis by drug disclosed that rofecoxib (RR, 1.39 [95%CI, 1.31-1.47]), followed by 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. Analysis by type of event showed that the highest risk corresponded to vascular events for both coxibs (RR, 2.18 [95%CI, 1.72-2.78]) and nonselective NSAIDs (RR, 2.46 [95%CI, 2.00-3.02]). The meta-analysis results suggest that the use of the marketed coxibs celecoxib and etoricoxib would be related to a statistically significant CVR increase. Etoricoxib CVR could be higher than that for celecoxib. This increment would be similar to classical NSAID CVR.

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Non-steroidal anti-inflammatory drugs and risk of cerebrovascular events in patients with osteoarthritis: a nested case–control study

Cited by 18 publications

References 44 publications

Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies

Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies

The Role of miRNAs in Common Inflammatory Arthropathies: Osteoarthritis and Gouty Arthritis

Cardiovascular Risk of Nonsteroidal Anti‐inflammatory Drugs and Classical and Selective Cyclooxygenase‐2 Inhibitors: A Meta‐analysis of Observational Studies

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