In patients with rheumatoid arthritis or osteoarthritis at higher risk for cardiovascular events, celecoxib may be safer compared with naproxen or ibuprofen when these drugs are taken alone or in combination with aspirin, according to a study published in Journal of the American College of Cardiology.

In this post hoc analysis of a trial that compared 3 nonsteroidal anti-inflammatory drugs (NSAIDs), 23,953 patients with osteoarthritis or rheumatoid arthritis at increased cardiovascular risk were randomly assigned to receive celecoxib, ibuprofen, or naproxen. In each group, 46% of participants also received low-dose aspirin.

When all three NSAIDs were pooled together, the addition of aspirin vs no aspirin resulted in comparable safety levels (P =.13). Intake of celecoxib in combination with aspirin vs celecoxib alone reduced safety levels due to a higher rate of major adverse cardiovascular events (P =.003).

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Naproxen alone and ibuprofen alone were associated with reduced safety compared with celecoxib alone (P <.001 for both). Ibuprofen was associated with a greater risk for adverse cardiovascular events compared with celecoxib (P =.039), naproxen vs celecoxib, with a greater risk for renal events (P =.024) and the risk for gastrointestinal events was greater with naproxen and ibuprofen compared with celecoxib (P <.001 for both).

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Among study limitations, researchers noted that its hypothesis-generating nature.  “Our findings underscore the importance of appropriate patient counseling on the relative safety profile of NSAIDs when initiating therapy…Physicians administering any NSAID should consider the potential [gastrointestinal] and renal hazards of using combined NSAID and aspirin therapy,” concluded the study authors.


Reed G, et al. Effect of aspirin coadministration on the safety of celecoxib, naproxen, or ibuprofen [published online April 24, 2018]. J Amer Coll Cardiol. doi:10.1016/j.jacc.2018.02.036

This article originally appeared on Clinical Pain Advisor