Simultaneous assessment of short-term gastrointestinal benefits and cardiovascular risks of selective cyclooxygenase 2 inhibitors and nonselective nonsteroidal antiinflammatory drugs - An instrumental variable analysis
Simultaneous assessment of short-term gastrointestinal benefits and cardiovascular risks of selective cyclooxygenase 2 inhibitors and nonselective nonsteroidal antiinflammatory drugs - An instrumental variable analysis
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DOI：
10.1002/art.22219
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发表时间：
2006-11-01
影响因子：
--
通讯作者：
Brookhart, M. Alan
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文献类型：
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作者：
Schneeweiss, Sebastian;Solomon, Daniel H.;Brookhart, M. Alan
Objective.采用工具变量分析法同时评估塞来昔布与罗非昔布和几种非选择性非甾体类抗炎药（NSAIDs）相比在短期内降低胃肠道（GI）并发症风险和增加急性心肌梗死（MI）风险的作用。在1999年1月1日至2002年12月31日期间，确定了49，711名年龄在65岁及以上的Medicare受益人，他们开始了非选择性NSAID或选择性环氧合酶2抑制剂治疗。使用工具变量分析评估开始NSAID（罗非昔布、双氯芬酸、布洛芬和萘普生与塞来昔布相比）治疗后180天内GI并发症和MI风险的增加。与非选择性NSAID相比，塞来昔布使GI并发症风险降低1.4/100使用者，但使MI风险增加0.3/100使用者。罗非昔布使GI并发症减少了1.1/100，使MI风险增加了0.3/100。使用塞来昔布作为参考暴露量，罗非昔布（风险差异[RD] 1.40，95%置信区间[95% CI]-0.20，3.01）和双氯芬酸（RD 6.07，95% CI-0.02，12.15）的MI风险增加。萘普生的RD及其95%CI上限是所有NSAID中最低的（RD-0. 30，95% CI-2. 74，2.14），所有NSAID之间的胃肠道并发症发生率无显著差异。在该工具变量分析中，双氯芬酸和罗非昔布在老年人中的NSAID获益-风险平衡最差。
Objective. To simultaneously assess the short-term reduction in risk of gastrointestinal (GI) complications and increase in risk of acute myocardial infarction (MI) by celecoxib compared with rofecoxib and several nonselective nonsteroidal antiinflammatory drugs (NSAIDs) using instrumental variable analysis.Methods. A population of 49,711 Medicare beneficiaries ages 65 years and older who initiated nonselective NSAID or selective cyclooxygenase 2 inhibitor therapy between January 1, 1999, and December 31, 2002, was identified. The increase in risk of GI complications and MI within 180 days after initiation of NSAID (rofecoxib, diclofenac, ibuprofen, and naproxen compared with celecoxib) therapy was assessed using instrumental variable analysis.Results. Compared with nonselective NSAIDs, celecoxib reduced the risk of GI complications by 1.4 per 100 users but increased the risk of MI by 0.3 per 100 users. Rofecoxib decreased GI complications by 1.1 per 100 users and increased the risk of MI by 0.3 per 100 users. Using celecoxib as the reference exposure showed an increase in the MI risk for rofecoxib (risk difference [RD] 1.40, 95% confidence interval [95% CI] -0.20, 3.01) and diclofenac (RD 6.07, 95% CI -0.02, 12.15). The RD for naproxen as well as its upper 95% CI was the lowest of all NSAIDs (RD -0.30, 95% CI -2.74, 2.14) and there was no significant difference in GI complication rates among all NSAIDs.Conclusion. In this instrumental variable analysis, diclofenac and rofecoxib had the least favorable benefit-risk balance among NSAIDs in older adults.