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Research:
Linda E. Lévesque, James M. Brophy, and Bin Zhang
Time variations in the risk of myocardial infarction among elderly users of COX-2 inhibitors
CMAJ 2006; 174: 1563-1569 [Abstract] [Full text] [PDF]
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[Read eLetter] "Risk" may be explained by efficacy
Andrew J Ashworth   (16 May 2006)

"Risk" may be explained by efficacy 16 May 2006
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Andrew J Ashworth

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Re: "Risk" may be explained by efficacy

Andrew.ashworth{at}lothian.scot.nhs.uk Andrew J Ashworth

These findings are interesting but may reflect the superiority of ROFECOXIB over other agents as an analgesic and effective anti- inflammatory rather than any specific cardiotoxic effect. The peak of cardiac events in the second week of treatment might simply be related to increased activity of individuals whoe previous disease induced pain, reduced activity and therefore degraded physical fitness. With a half life of 24 hours, it takes six half lives (about a week) to reach steady state and therefore maximumum sustained efficacy. That the peak dropped back towards baseline after the second week would, on this interpretation, be explained by the improved cardiac fitness induced by a further week of increased physical activity.

Perhaps we should be careful about how well we treat longstanding arthritis in those who long to be more active again.

Had the same quantative observations been made for SILDANAFIL (Viagra) the authors' qualitative (and speculative) interpretation might have been different!

Conflict of Interest:

None declared