Valat Jean-Pierre, Deray Gilbert, Héloire François
Université François Rabelais, Faculté de Médecine, Tours.
Presse Med. 2006 Sep;35 Suppl 1:25-34. doi: 10.1016/S0755-4982(06)74937-5.
Three placebo-controlled studies have demonstrated deleterious cardiovascular (CV) effects of rofecoxib, celecoxib, and pare/valdecoxib. It remains to be determined whether this CV toxicity is specific to coxibs, or shared with all non-steroidal anti-inflammatory drugs (NSAID). Seven meta-analyses show that, in comparison with non-specific NSAIDs, the risk of thrombotic CV accident is increased with rofecoxib and celecoxib, but not with valdecoxib or lumiracoxib. Concerning the risk of thrombotic CV accident, seven of the ten observational studies which have evaluated the risk, have found an increased risk for the non-specific NSAID in comparison with non-exposed subjects,. The seven observational studies, which evaluated the risk of coxibs, have all found an increased risk with rofecoxib, and two with celecoxib. Three studies out of six have shown an increase of risk with rofecoxib and one study out of five with celecoxib. Two of the three studies, which have compared rofecoxib with celecoxib, have found an increased risk with rofecoxib. Concerning the risk of arterial hypertension, oedemas or congestive cardiac insufficiency, a meta-analysis and a randomised trial have shown a deleterious effect of rofecoxib in comparison with celecoxib and non-specific NSAID. Two studies have shown a deleterious effect of the non-selective NSAID and three a deleterious effect of rofecoxib in comparison with non-exposed subjects. Three studies have demonstrated a deleterious effect of rofecoxib in comparison with non-specific NSAID. No study has shown any deleterious effect of celecoxib in comparison with subjects non-exposed or exposed to non-specific NSAID. These studies suggest that all the NSAID, specific or not, increase the CV and renal risk. This risk seems variable from a compound to another one and must be evaluated, for each patient, according to the susceptibility and associated risk factors. While waiting for other long-term controlled studies, the available data show the existence of a risk of CV secondary effect linked to the class of NSAID, specific (coxibs) or not.
三项安慰剂对照研究已证明罗非昔布、塞来昔布和帕罗西汀/伐地昔布对心血管（CV）有不良影响。这种CV毒性是否特定于环氧化酶抑制剂，还是所有非甾体抗炎药（NSAID）都有，仍有待确定。七项荟萃分析表明，与非特异性NSAID相比，罗非昔布和塞来昔布会增加血栓性CV事故的风险，但伐地昔布或卢米昔布不会。关于血栓性CV事故的风险，十项评估该风险的观察性研究中有七项发现，与未暴露的受试者相比，非特异性NSAID的风险增加。七项评估环氧化酶抑制剂风险的观察性研究均发现罗非昔布风险增加，两项发现塞来昔布风险增加。六项研究中有三项显示罗非昔布风险增加，五项研究中有一项显示塞来昔布风险增加。三项比较罗非昔布和塞来昔布的研究中有两项发现罗非昔布风险增加。关于动脉高血压、水肿或充血性心力衰竭的风险，一项荟萃分析和一项随机试验表明，与塞来昔布和非特异性NSAID相比，罗非昔布有不良影响。两项研究表明非选择性NSAID有不良影响，三项研究表明与未暴露的受试者相比罗非昔布有不良影响。三项研究表明与非特异性NSAID相比罗非昔布有不良影响。没有研究表明与未暴露或暴露于非特异性NSAID的受试者相比，塞来昔布有任何不良影响。这些研究表明，所有NSAID，无论是否特异性，都会增加CV和肾脏风险。这种风险似乎因化合物而异，必须根据每位患者的易感性和相关风险因素进行评估。在等待其他长期对照研究的同时，现有数据表明存在与NSAID类别相关的CV继发效应风险，无论是否特异性（环氧化酶抑制剂）。
