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COX-2-selective NSAIDs and risk of hip or knee replacements: a population-based case-control study

Corinne Klop1, Frank de Vries, Arief Lalmohamed

  • 1Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.

Calcified Tissue International
|October 12, 2012
PubMed

Insights

Long-term use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) showed no difference in hip or knee replacement risk compared to COX-2 selective NSAIDs (coxibs). This suggests coxibs may not slow osteoarthritis progression.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Epidemiology

Background:

  • Osteoarthritis (OA) disease models suggest COX-2 selective NSAIDs (coxibs) may benefit cartilage.
  • Clinical evidence supporting this hypothesis is limited.

Purpose of the Study:

  • To compare the risk of hip or knee replacement surgery between long-term users of coxibs and nonselective NSAIDs.
  • To investigate potential disease-modifying effects of coxibs in osteoarthritis patients.

Main Methods:

  • Population-based case-control study using the Dutch PHARMO Record Linkage System (2000-2009).
  • 26,202 cases with first hip or knee replacement matched with controls.
  • Conditional logistic regression analysis adjusted for disease and drug history.

Main Results:

  • Long-term nonselective NSAID use was not associated with a different risk of hip replacement (aOR=0.89) or knee replacement (aOR=0.74) compared to long-term coxib use.
  • Results remained consistent across subgroups stratified by gender, age, and comorbidities.

Conclusions:

  • Long-term nonselective NSAID users and long-term coxib users exhibit similar risks for hip or knee replacement.
  • Current findings do not support the use of coxibs to slow osteoarthritis progression.

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