COX-2 INHIBITORS AS A CAUSE OF HEART AND RENAL FAILURE

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Non-steroid anti-inflammatory drugs (NSAIDs) have pain-killing and anti-inflammatory properties. For many years Australia had a higher use of these drugs than other countries. The drugs are quite toxic, and in susceptible individuals may cause ulceration and bleeding from the stomach and duodenum, kidney damage and fluid congestion leading to heart failure. Each of these conditions carries a high morbidity, particularly in the elderly. Because of concerns about toxicity, the use of NSAIDs in Australia fell during the 1990s by around 40%. Newer allegedly safer forms of NSAIDs called COX-2 inhibitors have been introduced into the Australian market. The first 2 drugs to be marketed are called Celebrex and Vioxx. These drugs appear to be safer for the stomach and duodenum, but the true effects on the kidney and heart are as yet unclear. COX-2 inhibitors have been very widely used with over 1.7 million prescriptions issued since their listing on the Pharmaceutical Benefits Scheme in August 2000. Most of this use appears to be in addition to prescribing of the older NSAIDs rather than as a replacement for them. The purpose of this study is to compare the safety of the new COX-2 inhibitors with that of the older NSAIDs. We are interested in how often they cause renal failure and heart failure. The investigators will use well-established research methods to estimate the risk of heart failure and kidney failure with these drugs in the Australian community. Data from the study will form the basis of clinical practice guidelines for the safe use of these drugs in Australia.