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Arthritis Medications and Cardiovascular Events
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To the Editor: I would like to add a cautionary comment to Dr Topol’s Editorial discussing the apparent prothrombotic hazard of COX-2 inhibitors.1 The excess number of thrombotic events with rofecoxib and celecoxib in the trials assessing their ability to inhibit the development of colonic adenomas is potentially a confounding effect generated by their analgesic properties.
Headaches, backaches, and many other kinds of pain are ubiquitous, as is self-administration of analgesics, including aspirin and other NSAIDs. It is plausible that the individuals in the polyp prevention studies who were receiving the COX-2 inhibitors had less pain and took less out-of-study analgesic medications. If so, the observation of a relative excess of thrombosis in the COX-2 groups could have been due to out-of-study analgesics ingested by the control group having a protective effect against thrombosis. The selective COX-2 inhibitors, which may inhibit the emergence of cancer, ought not be discarded prematurely.
Simeon Pollack, MD
simeonpollack@optionline.net
Albert Einstein College of Medicine
Bronx, NY
1. Topol EJ. Arthritis medicines and cardiovascular events—"house of coxibs." JAMA. 2005;293:366-368.
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Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2005;293:1976.
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