Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 11361 - 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
Inflammopharmacology. 2015 Feb;23(1):1-16. doi: 10.1007/s10787-014-0225-9. Epub 2014 Dec 17.
Non-steroidal anti-inflammatory drugs (NSAIDs) are known to increase the risk of cardiovascular (CV) and renal incidences, especially at higher doses and upon long term use. However, the available reports are criticized for lack of specificity, grouping of vastly different outcomes together and ignoring the heterogeneity among NSAIDs. In this systematic review, we are reporting CV/renal risks associated with meloxicam, stratified into myocardial, vascular, renal risk categories, to address the differential nature of NSAIDs effects on different body systems. We are also reporting composite CV/renal risk to present overall risk associated with various covariates.
We searched the online healthcare databases for observational studies or randomized controlled trials, reporting myocardial or all-cause mortality outcome (>90 days exposure) and/or vascular/renal outcomes (any exposure) after meloxicam use, published until April 2014. The combined odd ratio values (OR'; 95% CI) were calculated using the random effect inverse variance model.
We found 19 eligible studies out of 2,422 reports. Meloxicam demonstrated a low increase in composite risk (OR' 1.14; CI 1.04-1.25) which was mainly vascular in nature (OR' 1.35; CI 1.18-1.55] as it did not elevate myocardial (OR' 1.13; CI 0.98-1.32) or renal (OR', 0.99; CI 0.72-1.35) risks. Relative to meloxicam, other NSAIDs increased the composite risk, in a dose-dependent fashion, in the following order: rofecoxib > indomethacin > diclofenac > celecoxib > naproxen > ibuprofen. OR' was also influenced by type of disease and the comparator used, and acetylsalicylic acid.
NSAIDs are heterogeneous in increasing CV/renal risks. The low increased risk associated with meloxicam is mainly vascular in origin.
非甾体抗炎药（NSAIDs）已知会增加心血管（CV）和肾脏事件的风险，尤其是在较高剂量和长期使用时。然而，现有的报告因缺乏特异性、将差异极大的结果混为一谈以及忽略 NSAIDs 之间的异质性而受到批评。在这项系统评价中，我们报告了与美洛昔康相关的 CV/肾脏风险，分为心肌、血管、肾脏风险类别，以解决 NSAIDs 对不同身体系统的不同作用的差异性质。我们还报告了复合 CV/肾脏风险，以呈现与各种协变量相关的总体风险。
我们在在线医疗保健数据库中搜索了观察性研究或随机对照试验，报告了美洛昔康使用后超过 90 天的心肌或全因死亡率结局（>90 天暴露）和/或血管/肾脏结局（任何暴露），发表时间截至 2014 年 4 月。使用随机效应逆方差模型计算联合比值比值（OR';95%CI）。
我们在 2422 份报告中找到了 19 项符合条件的研究。美洛昔康显示复合风险略有增加（OR'1.14;CI1.04-1.25），主要是血管性质（OR'1.35;CI1.18-1.55），因为它没有增加心肌（OR'1.13;CI0.98-1.32）或肾脏（OR',0.99;CI0.72-1.35）风险。与美洛昔康相比，其他 NSAIDs 以剂量依赖性方式增加了复合风险，顺序为：罗非昔布>吲哚美辛>双氯芬酸>塞来昔布>萘普生>布洛芬。OR'也受疾病类型和使用的比较药物以及乙酰水杨酸的影响。
NSAIDs 在增加 CV/肾脏风险方面存在异质性。与美洛昔康相关的低风险增加主要是血管源性的。
