Myths and facts in the use of anti-inflammatory drugs

Figures & data

Table

ACE	angiotensin-converting enzyme
AMI	acute myocardial infarction
ASA	aspirin (acetylsalicylic acid)
AT1	angiotensin type 1
BP	blood pressure
CHD	coronary heart disease
CHF	congestive heart failure
CNS	central nervous system
CV	cardiovascular
COX-2	cyclo-oxygenase 2
GI	gastrointestinal
OA	osteoarthritis
PG	prostaglandin
PPIs	proton pump inhibitors
RA	rheumatoid arthritis
RCTs	randomized clinical trials
SSRIs	selective serotonin reuptake inhibitors
t-NSAIDs	traditional (non-selective) non-steroidal anti-inflammatory drugs
UGIB	upper GI bleeding

Figure 1.  Relative risk (95% confidence intervals) for admission for complicated upper gastrointestinal events during each time-period of continuous exposure (mean value shown as upper dotted line) and during each time period of subsequent continuous non-exposure to non-steroidal anti-inflammatory drugs (NSAIDs) [30].

Figure 2.  Meta-analysis using the fixed-effects model of RCTs reporting dyspeptic symptoms in patients who received COX-2-selective versus t-NSAIDs. Summary estimate is the relative risk with 95% confidence intervals [42].

Table I.  Risk for GI hospitalization amongst a cohort of elderly patients taking t-NSAIDs or coxibs and requiring CV protection with low-dose aspirin [71].

Treatment	Hazard ratio (95% CI)
t-NSAIDs only (reference)	1
t-NSAIDs + aspirin	1.61 (1.02–2.56)
Coxibs	0.62 (0.45–0.81)
Coxibs + aspirin	0.86 (0.63–1.17)
Coxibs + aspirin versus t-NSAIDs + aspirin	0.53 (0.34–0.83)

Table II.  Risk factors for renal side-effects of NSAIDs [75].

Risk factor
Pre-existing renal impairment
Dehydration
Sodium depletion by diet or diuretics
Congestive heart failure
Liver cirrhosis with ascites
Lupus nephritis
Postsurgical status
Co-medication with nephrotoxic drugs (e.g. aminoglycosides, cyclosporine)
Co-medication with ACE inhibitors, angiotensin type 1 (AT1) receptor antagonists
Co-medication with potassium-sparing diuretics

Figure 3.  Adjusted hazard ratios (95% confidence intervals) for death and recurrent congestive heart failure (combined and alone) in patients taking NSAIDs or coxibs, according to exposure group [83].

Table III.  CV risk in t-NSAID users: effect of smoking and frequency of drug intake [96].)

	Relative risk	95% Confidence intervals
t-NSAIDs	1.44	1.27–1.65
Current smoker	1.82	1.38–2.42
Past smoker	1.58	1.28–19.5
Never smoked	1.11	0.88–1.41
>15 packets/week	1.86	1.27–2.73

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