Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a lower risk for cardiovascular events compared with oral NSAIDs in patients with rheumatoid arthritis (RA), according to findings from a retrospective study published in the Journal of the American Heart Association.

The researchers evaluated data from the Taiwan National Health Insurance Research Database, which includes individuals with incident RA starting therapy with topical or oral NSAIDs. The study monitored a total of 10,758 episodes and 78,056 episodes for topical and oral NSAID treatments, respectively. A composite of cardiovascular events, including heart failure, stroke, and myocardial infarction, was the study’s primary outcome. 

The unadjusted cardiovascular event rate was found to be 1.83 per 100 person-years for topical NSAIDs and 2.14 per 100-person years for oral NSAIDs. Overall, patients who had been taking topical NSAIDs had a 36% lower risk for cardiovascular events than those in the oral NSAID group. The risk for cardiovascular events in patients taking topical vs oral NSAIDs was lower after multivariable Cox regression analysis (hazard ratio, 0.54; 95% CI, 0.37-0.77).

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A limitation of this study is its short (6-month) monitoring period for assessment of cardiovascular events. Additionally, the small sample size reduces the overall power of the findings.

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Although the US Food and Drug Administration recently strengthened warning labels for cardiovascular events associated with the use of NSAIDs of all types, the researchers of this study comment that, “topical nonselective NSAIDs may be a safer alternative for relieving muscle-skeletal pain in patients with cardiovascular diseases.”

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Lin T-C, Solomon DH, Tedeschi SK, Yoshida K, Yang Y-HK. Comparative risk of cardiovascular outcomes between topical and oral nonselective NSAIDs in Taiwanese patients with rheumatoid arthritis. J Am Heart Assoc. 2017;6(11):e006874.