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

非类固醇抗炎药(NSAIDs)具有止痛和抗炎的特性。多年来，澳大利亚对这些药物的使用率高于其他国家。这些药物毒性很大，在易感人群中可能会导致胃部和十二指肠的溃疡和出血，肾脏损伤和液体充血导致心力衰竭。每一种情况都有很高的发病率，特别是在老年人中。由于对毒性的担忧，澳大利亚的非类固醇抗炎药的使用量在20世纪90年代下降了约40%。被称为COX-2抑制剂的较新的据称更安全的非类固醇抗炎药已经进入澳大利亚市场。首批上市的两种药物分别为西莱布司和万络。这些药物似乎对胃和十二指肠更安全，但对肾脏和心脏的真正影响尚不清楚。COX-2抑制剂自2000年8月列入药品福利计划以来，已经得到了非常广泛的使用，开出了超过170万张处方。大多数这种用途似乎是对较老的非类固醇抗炎药的处方的补充，而不是作为它们的替代品。本研究的目的是比较新的COX-2抑制剂和旧的非甾体抗炎药的安全性。我们感兴趣的是它们引起肾功能衰竭和心力衰竭的频率。研究人员将使用成熟的研究方法，在澳大利亚社区使用这些药物来估计心力衰竭和肾衰竭的风险。这项研究的数据将构成澳大利亚安全使用这些药物的临床实践指南的基础。

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.