The use of NSAIDs in rheumatology could be improved by an appropriate risk scoring system that accounts for adverse events such as bleeding and thrombosis. Such a risk score has now been developed using data from the PRECISION trial, but is this score ready to be applied in clinical practice?
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Nissen, S. E. et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N. Engl. J. Med. 375, 2519–2529 (2016).
Solomon, D. H. et al. Validation of a major toxicity risk score among NSAID users based on data from a randomized controlled trial. Arthritis Rheumatol. https://doi.org/10.1002/art.40870 (2019).
Gunaydin, C. & Bilge, S. S. Effects of nonsteroidal anti-inflammatory drugs at the molecular level. Eurasian J. Med. 50, 116–121 (2018).
Bombardier, C. et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N. Engl. J. Med. 343, 1520–1528 (2000).
Silverstein, F. E. et al. Gastrointestinal toxicity with celecoxib versus nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib long-term arthritis safety study. JAMA 284, 1247–1255 (2000).
Schnitzer, T. J. et al. Comparison of lumiracoxib with naproxen and ibuprofen in the therapeutics arthritis research and gastrointestinal event trial (TARGET), reduction in ulcer complications: randomised control trial. Lancet 364, 665–674 (2004).
Trelle, S. et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 342, c7086 (2001).
US Food and Drug Administration. Nonsteroidal anti-inflammatory drugs (NSAIDs). FDA https://www.fda.gov/Drugs/DrugSafety/ucm103420.htm (updated 10 May 2016).
European Medicines Agency. PRAC recommends the same cardiovascular precautions for diclofenac as for selective COX-2 inhibitors. EMA https://www.ema.europa.eu/en/news/prac-recommends-same-cardiovascular-precautions-diclofenac-selective-cox-2-inhibitors (2013).
Kanis, J. A. et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos. Int. 19, 385–397 (2008).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
M.T.N. declares he has received research support and lecture fees from Abbvie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi and UCB; and has been on the advisory boards for Abbvie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi and UCB.
Rights and permissions
About this article
Cite this article
Nurmohamed, M.T. Can personalized use of NSAIDs be a reality in the clinic?. Nat Rev Rheumatol 15, 387–388 (2019). https://doi.org/10.1038/s41584-019-0225-7
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41584-019-0225-7
