Renal Safety of NSAIDs Confirmed in Large Study of RA Patients....
June 25, 2010 (Rome, Italy) — The use of nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase (COX)-2 selective inhibitors (coxibs), did not adversely affect renal function in patients with rheumatoid arthritis (RA), according to the results of one of the largest prospective studies to examine renal toxicity in RA patients, Swiss investigators reported here at the European League Against Rheumatism Congress 2010.
"In addition to the known gastrointestinal and cardiovascular risks, the renal safety of NSAIDs has long been questioned. When I started this study, I had a dark image of NSAIDs and renal function. This study shows that NSAIDs are safe in the large majority of RA patients, and these drugs should not be withheld for reasons of anticipated renal toxicity," stated lead author Burkhard Möller, MD, from Bern University Hospital in Switzerland.
The study population was a nested cohort of more than 4000 patients with at least 2 documented glomerular filtration rates (GFR) who were enrolled in the Swiss RA Registry. Patients were observed for a mean of 3.1 years. Mean drug exposure time was 2.5 years for conventional NSAIDs and 0.5 years for coxibs. The investigators looked at never or ever use of NSAIDs, coxib use, and cumulative dose effect.
At baseline, there were 1362 never users and 2745 ever users. About 75% were female, mean disease duration was 4 years, and more than 60% had been treated with methotrexate.
Never users had a slightly lower GFR rate at baseline, Dr. Möller said. However, over the course of 3 years, the slopes of the curves for never and ever users were similar. No effect on GFR was observed in the longitudinal analysis, with the exception of patients with stage 4 or 5 chronic kidney disease, who had a significantly greater mean loss of GFR (P = .045), which he called "a small marginal effect with use of NSAIDs."
The median annual change in GFR in ever users was 1.3 mL/min. Initiation or continuation of NSAID exposure, or exposure to the subgroup of coxibs, significantly modified the clearance rate. No single NSAID was associated with a decline in GFR in annual analyses.
"The annual change in GFR was no different with or without NSAID exposure. No obvious loss in GFR was seen with long-term use of NSAIDs, except in patients with a baseline GFR below 30 mL/min," he stated.
Dr. Möller said the strengths of this study include its size and the fact that it is based on real-life data
He emphasized that "NSAIDs should be used responsibly. Control for GFR and repeat safety measures from time to time, but don't withhold these drugs for anticipated renal toxicity."
NSAIDs should not be used in stage 4 or 5 chronic kidney disease, and kidney function should be controlled in stage 3 patients started on NSAIDs, he added.
อ่านเพิ่มเติมได้ที่ : Medscape Pharmacist (http://www.medscape.com/viewarticle/724183?src=mp&spon=44&uac=12159BG)
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