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Meta-Analysis
. 2006 Mar;99(3):132-40.
doi: 10.1177/014107680609900315.

Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis

Brent Caldwell  1 , Sarah Aldington, Mark Weatherall, Philippa Shirtcliffe, Richard Beasley
Affiliations
Meta-Analysis

Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis

Brent Caldwell et al. J R Soc Med. 2006 Mar.

Abstract

Objectives: To examine whether the increased risk of cardiovascular events with rofecoxib represents a class effect of cyclooxygenase-2 (COX-2) specific inhibitors.

Design: Systematic review and meta-analysis of randomized double-blind clinical trials of celecoxib of at least 6 weeks' duration and presented data on serious cardiovascular thromboembolic events. Data sources included six bibliographic databases, the relevant files of the United States Food and Drug Administration, and pharmaceutical company websites.

Main outcome measures: Pooled fixed effects estimates of the odds ratios for risk of cardiovascular events with celecoxib compared with comparator treatment were calculated using the inverse variance weight method. The main outcome measure was myocardial infarction.

Results: Four placebo-controlled trials with 4422 patients were included in the primary meta-analysis comparing celecoxib with placebo. The odds ratio of myocardial infarction with celecoxib compared to placebo was 2.26 (95%confidence interval 1.0 to 5.1). For composite cardiovascular events [odd ratio 1.38 (95% CI 0.91 to 2.10)], cardiovascular deaths [OR 1.06 (95% CI 0.38 to 2.95)] and stroke [OR 1.0(95% CI 0.51 to 1.84)] there was no significant increase in risk with celecoxib. The secondary meta-analysis which included a total of six studies (with placebo, diclofenac, ibuprofen, and paracetamol as comparators) of 12 780 patients, showed similar findings with a significant increased risk with celecoxib for myocardial infarction [OR 1.88 (95% CI 1.15 to 3.08)] but not other outcome measures.

Conclusion: The available data indicate an increased risk of myocardial infarction with celecoxib therapy, consistent with a class effect for COX-2 specific inhibitors.

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Figures

Figure 1
Figure 1
Process of inclusion of studies in systematic review. NSAID, non-steroidal anti-inflammatory drug
Figure 2
Figure 2
Forest plot of the log of the ratio for risk of myocardial infarction with the use of celecoxib compared to placebo, using the inverse variance weighting method (areas inversely proportional to the variance of the estimate). MI, myocardial infarction
Figure 3
Figure 3
Forest plot of the log of the ratio for risk of myocardial infarction with the use of celecoxib compared to all comparator treatments (including placebo, diclofenac, ibuprofen, and paracetamol), using the inverse variance weighting method (areas inversely proportional to the variance of the estimate). MI, myocardial infarction
See this image and copyright information in PMC

Comment in

  • Celecoxib.
    Cheung R, Lowry S. Cheung R, et al. J R Soc Med. 2006 Jul;99(7):336. doi: 10.1177/014107680609900714. J R Soc Med. 2006. PMID: 16816261 Free PMC article. No abstract available.

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