Study: Celecoxib vs Ibuprofen vs Naproxen for Treating RA and OA

Celecoxib, a selective Cox-2 nonsteroidal anti-inflammatory drug (NSAID), is non-inferior to prescription doses of ibuprofen and naproxen for treating patients with osteoarthritis (OA) and rheumatoid arthritis (RA), according to a new study.

The findings were presented at the American College of Rheumatology Annual Meeting on Tuesday, November 15, 2016.

NSAIDs are commonly prescribed to patients with OA and RA, although the impact of NSAIDs and celecoxib on cardiovascular (CV) health remains unclear.

To better understand the risks, the researchers conducted the PRECISION study, which enrolled 24,081 patients with a history of CV events or with known CV risk factors from 923 sites in 13 countries.

Patients were included in the trial if they had a clinical diagnosis of OA or RA, needed daily NSAID therapy, had no CV events within the previous 90 days, and had no contraindications to the use of the treatments.

The patients were randomly assigned to receive either celecoxib 100 mg to 200 mg twice daily, ibuprofen 600 mg to 800 3 times daily, or naproxen 375mg to 500 mg twice daily. All patients were given open-label esomeprazole, 20 mg to 40 mg qd, and aspirin was given as standard care, if applicable.

Of the total, 90% patients had OA and 10% had RA. About 80% of patients adhered to treatment throughout study.

Among patients with OA, celecoxib was associated with a 16% decreased risk of a major adverse cardiac event compared with ibuprofen, a 32% lower risk of gastrointestinal events compared with ibuprofen and a 27% lower risk compared with naproxen, and a decreased number of renal events compared with ibuprofen.

Among patients with RA, the cardiac event rate was similar among all 3 treatment groups. No significant reduction in gastrointestinal risk was seen, but celecoxib reduced the all-cause mortality rate by 50%.

“PRECISION represents the largest CV safety trial of commonly used NSAIDs among patients with OA or RA,” the researchers concluded. “The results to be presented will clarify whether these NSAIDs carry the same CV, (gastrointestinal), and renal risk across OA and RA patients.”

—Amanda Balbi

Reference:

Husni ME, Solomon DH, Wolski KE, Wisniewski LM, Nissen SE; the PRECISION Trial Investigators. The cardiovascular safety of celecoxib versus ibuprofen or naproxen in 24,081 patients with osteoarthritis or rheumatoid arthritis. Paper presented at: the American College of Rheumatology (ACR)/Association of Rheumatology Health Professionals (ARHP) Annual Meeting 2016; November 11-16, 2016; Washington, DC. https://acrabstracts.org/abstract/the-cardiovascular-safety-of-celecoxib-versus-ibuprofen-or-naproxen-in-24081-patients-with-osteoarthritis-or-rheumatoid-arthritis/. Accessed November 15, 2016.