Is coadministration of low dose aspirin with NSAIDs safe for patients with OA and RA?

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Is coadministration of low dose aspirin with NSAIDs safe for patients with OA and RA?

The analysis of the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen) trial revealed that Celecoxib has a more favourable overall safety profile as compared to naproxen or ibuprofen if administered without aspirin, as per a study issued in 'Journal of the American College of Cardiology'.

The safety of nonsteroidal anti-inflammatory drug (NSAID) and aspirin when administered together is not certain. This study aimed to differentiate between the safety of combining NSAIDs (Celecoxib, Naproxen, or Ibuprofen) with low-dose aspirin. In total, 23,953 patients with osteoarthritis or rheumatoid arthritis at increased cardiovascular risk were randomised to celecoxib, ibuprofen, or naproxen. The "on-treatment" population was recruited for this study. The outcomes comprised of composite major adverse cardiovascular events, non-cardiovascular death, gastrointestinal (GI) or renal events, and components of the composite. The Cox proportional hazards models were useful in comparing the outcomes among NSAIDs stratified by aspirin use after the propensity score adjustment. The cumulative probability of events was analysed using the Kaplan-Meier analysis. In comparison with celecoxib; the naproxen or ibuprofen had a greater risk for the primary composite endpoint when taken without aspirin. Also, ibuprofen portrayed more major adverse cardiovascular events (p < 0.05), and both ibuprofen and naproxen had more GI (p < 0.001) and renal (p < 0.05) events. When administered with aspirin, Ibuprofen had a higher risk for the primary composite endpoint; it was not significantly higher with naproxen. The major adverse cardiovascular events were similar among NSAIDs when administered with aspirin. Compared with celecoxib, ibuprofen had more GI and renal events (p < 0.05), while naproxen had more GI events (p < 0.05), without a difference in the renal events. The adjusted Kaplan-Meier analysis revealed similar results.

The study authors concluded, "Adding aspirin impairs the safety advantage of celecoxib, although celecoxib still leads to fewer gastrointestinal events than ibuprofen or naproxen and also fewer renal events than ibuprofen."


Journal of the American College of Cardiology


Original title of article

Effect of Aspirin Coadministration on the Safety of Celecoxib, Naproxen, or Ibuprofen


Grant W Reed et al.

Therapeutic, Aspirin, Celecoxib, Naproxen, Ibuprofen, Osteoarthritis, Rheumatoid arthritis, Coxibs, Nonsteroidal anti-inflammatory drug (NSAID), Analgesics, Analysis, Cardiovascular, Gastrointestinal, Safety, Renal
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