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

非甾体抗炎药（NSAIDs）具有止痛和抗炎的特性。多年来，澳大利亚使用这些药物的比例高于其他国家。这些药物毒性很大，在易感人群中可能导致胃和十二指肠溃疡和出血、肾脏损伤和导致心力衰竭的液体充血。这些疾病的发病率都很高，尤其是在老年人中。由于对毒性的担忧，20世纪90年代，澳大利亚非甾体抗炎药的使用量下降了约40%。被称为COX-2抑制剂的新型据称更安全的非甾体抗炎药已被引入澳大利亚市场。最早上市的两种药物是西乐葆和万络。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月列入药物福利计划以来，已被广泛使用，共发出超过170万张处方。大多数的使用似乎是作为老的非甾体抗炎药处方的补充，而不是作为它们的替代品。本研究的目的是比较新的COX-2抑制剂与旧的非甾体抗炎药的安全性。我们感兴趣的是它们引起肾衰竭和心力衰竭的频率。研究人员将使用成熟的研究方法来评估澳大利亚社区使用这些药物的心力衰竭和肾衰竭的风险。该研究的数据将构成澳大利亚这些药物安全使用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.