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In Reply: Dr Guslandi appropriately points out that each drug in a class needs to be assessed on a specific basis when it comes to adjudicating putative lack of safety. For the public and the physician community, the confusional state on arthritis medications was substantially exacerbated by the premature discontinuation of the ADAPT trial. Dr Lehmann notes that some of the patients in this trial were taking concomitant aspirin on an open-label basis, and that naproxen could theoretically have inhibited aspirin’s antiplatelet benefit akin to the well-described ibuprofen-aspirin interaction. It is also noteworthy that the ADAPT trial does not show any statistically significant excess in myocardial infarction or stroke. I believe that, until proven otherwise, naproxen should still be considered as the NSAID agent with the most favorable cardiovascular safety record.

Dr Pollack notes that COX-2 inhibitors may have a protective effect inhibiting colonic polyp formation, which appears to be . . . [Full Text of this Article]

Eric J. Topol, MD
topole@ccf.org
Department of Cardiovascular Medicine
Cleveland Clinic Foundation
Cleveland, Ohio

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