NSAID’s in the News (again)

Let me start by saying, that despite spending the last 20-something years in or around the pharmaceutical industry, I don’t like taking pills. That said, I’m not particularly partial to pain either. So when my knees or back hurts or I’m doubled over with dysmenorrhea, like many other people, I’ll reach for the ibuprofen.

But that may be about to change. Results from a new, large international study of non-steroidal anti-inflammatory drugs (NSAIDs), showed that high doses of them increase the risk of a major vascular event such as heart attack, stroke or death from cardiovascular disease by around a third.

In other words, for every 1,000 people with an average risk of heart disease who take high-dose ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.

This puts the heart risks of generic NSAIDs on a par with Vioxx – the painkiller that U.S. drugmaker Merck famously pulled from sale in 2004 because of links to heart risks.

The study team from Oxford University in the UK, gathered data, including on admissions to hospital, for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.

This allowed them to pool results from 639 trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.

In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.

Researcher, Colin Baigent stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of for long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.

He also warns patients not to make hasty decisions or change their treatment without consulting a doctor.

“For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs. They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”

Donald Singer, a professor of clinical pharmacology and therapeutics at Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects.”

In the meantime, I for one, will be revising my pain versus pill-popping habit, or switching to naproxen.

A Pill to Prevent Skin Cancer?

Summer, it seems, has finally arrived.  And with it comes long lazy days at the beach, the pool… and, unfortunately, the associated risk of skin cancer.  To guard against this we all know to limit sun exposure, use high factor sunscreen and seek shade. But now it seems there’s one more thing we can do to help safeguard ourselves – take Advil!

Really?   Yes, it would appear so.  According to a case-control study published in the journal Cancer, the use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with reduced risk for skin cancer.

Using health registries, researchers identified 18,500 cases of skin cancer among adults in northern Denmark and matched them to population controls without skin cancer. Patients who had ever used NSAIDs (more than two prescriptions) had a 15% reduced risk for squamous cell carcinoma and a 13% reduced risk for malignant melanoma compared with those who had two or fewer prescriptions; especially when the drugs were taken for seven or more years or at a high intensity.

The risk reduction was seen in patients taking aspirin, NSAIDs, and COX-2 inhibitors, such as Celebrex.

Individuals who took NSAIDs did not appear to gain a generally reduced risk from developing basal cell carcinoma, although they had a 15% and 21% reduced risk of developing this kind of cancer on less-exposed sites (areas other than the head or neck) when taken long term or at a high intensity, respectively.

So how do NSAIDs do it?  The authors suggest that they reduce the risk of skin cancer by blocking COX enzymes, which are involved in the inhibition of apoptosis  and in stimulating angiogenesis. Or, in plain English, these anti-inflammatory drugs counteract the enzymes involved in the important steps of cancer development such as inhibition of cell death and suppression of the immune system.

Despite the positive results, lead author Sigrún Alba Johannesdóttir from Aarhus University Hospital cautions, “because there are also risks associated with the use of NSAIDs, we cannot give recommendations on NSAID use in general. It is up to the patient and his or her physician to balance benefits and harms associated with use of the medications.”

Nevertheless, when viewed alongside the study results fom earlier this year that showed patients who took aspirin daily for at least three years were 36% less likely to develop metastatic cancer and 15% less likely to die from the disease, this can only be good news.

Especially for people like me, who love the sun and can’t make it downstairs without a morning dose of diclofenac!