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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Saturday, September 16, 2006

    Safe Arthritis Drugs: The newspapers last week were full of stories claiming that Naprosyn is the safest arthritis drug. Many of my patients brought the articles in to ask if they should switch. Some take Tylenol, some take ibuprofen, none of them take the newer "heart riskier" Celebrex. But the authors of the study that is purported to say that Naprosyn is safer say it isn't:

    Use of naproxen was not associated with any reduction in risk, as was suggested by the authors of a report of a large trial comparing it with rofecoxib.

    Certainly their graphic doesn't make it look safer, though their table of comparitive risk does make it look safer than the others (if only marginally.)

    There is this little addendum which seems to contradict the body of the report, even though the authors claim it doesn't:

    Since this article was submitted, Helin-Salmivaara and colleagues in Finland have published a population-based study of the risks of hospitalization with myocardial infarction and use of nonsteroidal anti-inflammatory drugs (Eur Heart J 2006;27:1657-1663; doi 10.1093/eurheartj/ehl053). We have not updated our systematic review but in view of the size of this study we believed it was important to determine if inclusion of the new data would change the results or conclusions of our study. Accordingly, we reran the analyses with inclusion of the new data. The revised summary RR estimates (95% CI) using a random-effects model are as follows: refecoxib, 1.36 (1.18-1.58; 12 studies); celecoxib, 1.06 (0.92-1.22; 12 studies); diclofenac, 1.40 (1.19-1.65; 10 studies); meloxicam, 1.24 (1.06-1.45; 4 studies); naproxen, 0.99 (0.89-1.09; 16 studies); ibuprofen, 1.09 (0.99-1.20; 17 studies); piroxicam, 1.16 (0.86-1.56; 5 studies); indomethacin, 1.36 (1.15-1.61; 7 studies). Our conclusions are unchanged: there appear to be clinically significant differences in summary RR estimates between individual drugs in the doses that are used in the community.

    What to make of all of those RR's? That there isn't all that much difference between drugs. At least not enough to warrant headlines. Which is probably why the author's of the article are rather non-plussed with the findings.

    posted by Sydney on 9/16/2006 09:08:00 PM 2 comments


    In the Friday Sept. 15, 2006 WSJ Sharon Begley writes about negative results and the need to publish this material to help research be cost effective and raising false hopes. She ends he article with this "Which goes to show how that in scientific journals, no less than in supermarket tabloids, you can't believe everything you read - or shouldn't."

    Steve Lucas

    By Anonymous Anonymous, at 3:58 PM  

    1) Agree with your post - the evidence that any NSAID (aside from COX2s which seem pretty clear) is more dangerous than any other is weak.
    2) Referring to Steve Lucas's post above, there's an interesting recent article with the a title along the lines of 'Why Most Published Studies are Wrong'. I wish I could remember the author/citation. But I still think they're better than the tabloids! ;)

    By Anonymous Carpus, at 11:18 AM  

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