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Can personalized use of NSAIDs be a reality in the clinic?

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?

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  1. Nissen, S. E. et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N. Engl. J. Med. 375, 2519–2529 (2016).

    Article  CAS  Google Scholar 

  2. 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. (2019).

    Article  PubMed  Google Scholar 

  3. Gunaydin, C. & Bilge, S. S. Effects of nonsteroidal anti-inflammatory drugs at the molecular level. Eurasian J. Med. 50, 116–121 (2018).

    Article  Google Scholar 

  4. 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).

    Article  CAS  Google Scholar 

  5. 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).

    Article  CAS  Google Scholar 

  6. 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).

    Article  CAS  Google Scholar 

  7. Trelle, S. et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 342, c7086 (2001).

    Article  Google Scholar 

  8. US Food and Drug Administration. Nonsteroidal anti-inflammatory drugs (NSAIDs). FDA (updated 10 May 2016).

  9. European Medicines Agency. PRAC recommends the same cardiovascular precautions for diclofenac as for selective COX-2 inhibitors. EMA (2013).

  10. 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).

    Article  CAS  Google Scholar 

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Correspondence to Michael T. Nurmohamed.

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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.

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Nurmohamed, M.T. Can personalized use of NSAIDs be a reality in the clinic?. Nat Rev Rheumatol 15, 387–388 (2019).

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