medwireNews: Current use of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, but not of naproxen, is associated with a threefold increased risk for myocardial infarction (MI) among individuals with spondyloarthritis (SpA), according to recent findings.
The odds ratio (OR) for MI among SpA patients taking diclofenac was 3.3 after accounting for covariates including BMI, and other cardiovascular risk factors, such as hyperlipidemia, diabetes, hypertension, and ischemic heart disease, and their treatment, the study authors report.
Writing in the Annals of the Rheumatic Diseases, researchers Maureen Dubreuil (Boston University School of Medicine, Massachusetts, USA) and colleagues say: “These results suggest that diclofenac use contributes to risk of MI in patients with SpA, and has the important implication for patients with SpA and clinicians that MIs could be prevented through preferential use of naproxen.”
Current diclofenac use was also associated with a significantly increased risk for MI in patients with osteoarthritis (OA), but the risk for SpA patients, by comparison, was higher, with a ratio of ORs of 2.64.
Although this ratio failed to reach significance in sensitivity analysis, the authors suggest that “one may speculate that this finding indicates a greater propensity for MI among patients with SpA than patients with OA.”
The findings were reached using a nested case–control study of real-world UK data from 1994 to 2015, which included 8140 adults with SpA and more than 244,000 with OA who were taking at least one NSAID of any type. Of these, 115 with SpA and 6287 with OA had an MI and each of these individuals was matched by age, date of SpA or OA diagnosis, and sex to up to four control individuals without an MI.
While current diclofenac use, defined as a prescription within 180 days of the index date, was associated with MI risk, there was no association with recent or remote NSAID use (180–365 days and >365 days, respectively) in patients with SpA .
NSAIDs are currently the first-line therapy for patients with axial SpA and psoriatic arthritis, and the researchers say that the top three NSAIDs of diclofenac, naproxen, and ibuprofen account for more than 12 million prescriptions each year in the UK.
“If confirmed in other large SpA datasets, these findings may motivate a change in practice guidelines to recommend naproxen as the preferred first-line NSAID in SpA,” they suggest.
By Catherine Booth
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