| New analysis suggests that almost all nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors have comparable efficacy and safety profiles when used to treat osteoarthritis. Almost all nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors have comparable efficacy and safety profiles when used to treat osteoarthritis, according to a report from the US Agency for Healthcare Research and Quality. The exception is the drug naproxen: Scientific evidence to date suggests that it has less effect on risk for myocardial infarction than other drugs in both classes. However, the researchers emphasized in the report that all drugs pose potential harms along with benefits. Patients differ widely on how they react to drugs, how they prioritize risks, and whether risks are acceptable when compared to a drug’s benefits. The report was written at the Evidence-based Practice Center at Oregon Health & Science University and was based on a systematic review of 360 published studies; t represents the most comprehensive analysis thus far of arthritis pain medications. Researchers compared the pain medications’ effectiveness and health risks, including myocardial infarction and gastric side effects, plus identified topics where more research is needed. While the review yielded important findings about the analgesics, it concluded more studies are needed about the drugs’ comparative risks, the consequences of long-term use, and the impact of dosing variations. The authors also suggested that genetic research may one day predict which patients are most likely to develop cardiovascular problems when taking the analgesics. “These findings represent a vital comparison of medications that are taken by millions of Americans,” said Agency Director Carolyn M. Clancy, MD. “The report also shines a bright light on questions that could further our knowledge and give patients research-based evidence to help them choose the best available treatment.” The report analyzed the risks and benefits of 26 medications. No clear difference was shown in pain-relief effectiveness between classes The analysis found that all tested medications can cause or worsen hypertension, congestive heart failure, peripheral edema, and impaired kidney function. Most of the evaluated medications pose similar increased risks for myocardial infarction with the apparent exception of naproxen. The risks of serious adverse gastrointestinal events for users of celecoxib are similar to the risks for users of nonsteroidal anti-inflammatory drugs. The researchers stressed that more research is needed to compare the cardiac and gastrointestinal risks of aspirin at doses effective for pain relief versus other nonsteroidal anti-inflammatory drugs. Acetaminophen generally reduces pain less effectively than anti-inflammatory drugs but carries a smaller risk of gastrointestinal problems. One study showed high doses posed myocardial infarction risks similar to the anti-inflammatory drugs. The new report, Comparative Effectiveness and Safety
of Analgesics for Osteoarthritis, is available at |