Arthritis drugs have similar risks and benefits
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The two main types of drugs used to treat osteoarthritis offer the same pain-relief benefits and pose a similar risk of causing heart attacks, according to a government review.
Naproxen is the single exception, carrying a lower risk of heart attack than the 25 other drugs included in the Agency for Healthcare Research and Quality (AHRQ) analysis.
Non-steroidal, anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen, represent one type of drug used to treat osteoarthritis, while the other group is a newer type of NSAID, known as COX-2 inhibitors, and includes drugs such as Celebrex.
COX-2 inhibitors were developed to avoiding the gastrointestinal problems that can be caused by NSAIDs, but were found to pose an increased risk of heart attack. Two COX-2 inhibitors, Bextra and Vioxx, were pulled from the market for this reason.
To clarify the risks and benefits of NSAIDs and COX-2 inhibitors, researchers at the AHRQ’s Evidence-based Practice Center at Oregon Health & Science University in Portland reviewed 360 studies of the drugs.
Based on numerous, high-quality trials, the authors concluded that COX-2 inhibitors and NSAIDs are equally effective for pain relief in osteoarthritis. Both types of drugs can cause or worsen high blood pressure, congestive heart failure, swelling and poor kidney function. However, COX-2 inhibitors are less likely to cause GI bleeding than NSAIDs.
There is also evidence that both types of drugs are more likely to cause cardiovascular and GI side effects in older patients, and the risk is greater in people with heart and kidney problems.
Studies of topical NSAIDs, drugs directly applied to the skin, show some promise, but the formulation that has shown the most effectiveness, diclofenac with DMSO, is not available in the US, the researchers note.
There is also evidence that glucosamine-chondroitin supplements may help relieve pain, and no evidence that they pose any risk. However the quality of the supplements available in the U.S; varies widely, and most of the studies examined used pharmaceutical-quality formulations that are not available in this country.
More research is needed to understand the long-term effects of both types of drugs, as well as their comparative risks and the effect of varied dosages on effectiveness and risk, the report’s authors conclude.
“At this time, although the amount and quality of evidence varies, no currently available analgesic reviewed in this report offers a clear overall advantage compared with the others,” they write. “As in other medical decisions, choosing the optimal analgesic for an individual with osteoarthritis should always involve careful consideration and thorough discussion of the relevant trade-offs.”
SOURCE: Agency for Healthcare Research and Quality, October 7, 2006.
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