COX-2 inhibitors linked to increased risk of stroke death

A new study published in the journal Neurology finds that some commonly prescribed drugs for arthritis and pain may increase the risk of dying from a stroke.

As well as being associated with a higher risk of death from stroke, COX-2 inhibitors have also been linked to increased risk of heart attacks and heart failure.

The drugs assessed in the study - COX-2 inhibitors - are a type of "selective" nonsteroidal anti-inflammatory drug (NSAID). 

Examples of COX-2 inhibitors include older drugs such as diclofenac, etodolac, nabumeton and meloxicam, and newer drugs like celecoxib and rofecoxib.

The researchers behind the study, from Aarhus University Hospital in Aarhus, Denmark, examined the medical records of 100,243 Danish people who were hospitalized for a first stroke between 2004 and 2012.

The team looked at information on these patients' history of COX-2 inhibitor use, including when they were using these drugs and what type of COX-2 inhibitors they were taking.

The study shows that people who were current users of COX-2 inhibitors were 19% more likely to die after a stroke than people who did not use COX-2 inhibitors. New users were found to be 42% more likely to die from stroke, compared with non-users.

The researchers also found that patients taking etodolac were 53% more likely to die from stroke, compared with non-users.

No links between "non-selective" NSAIDs and increased stroke death were reported by the study. Interestingly, chronic use of any of the drugs in the study was not linked to stroke mortality.

'These drugs should not be prescribed for those with existing stroke risk'

The researchers at Aarhus University Hospital in Aarhus, Denmark, say:

"While newer versions of these COX-2 inhibitor drugs have been pulled off shelves, older ones are still frequently prescribed. Our study provides further important evidence solidifying the risks of certain arthritic pain relievers and death from stroke."

This study supports stepping up efforts to make sure people with a higher risk of stroke are not prescribed these medications when other options are available.

Fast facts about stroke

• Stroke is the fourth leading cause of death in the US
• More than half of people who have a stroke are able to function and live at home. However, others are not able to care for themselves
• People who have an ischemic stroke (caused by a blood clot) are more likely to survive than those who have a hemorrhagic stroke (caused by bleeding in the brain).

Earlier this year, scientists from the Perelman School of Medicine at the University of Pennsylvania, PA, published a report in the Proceedings of the National Academy of Sciences of research into a potential new class of drugs that could provide a safer alternative to COX-2 inhibitors.

As well as being associated with a higher risk of death from stroke, COX-2 inhibitors have also been linked to increased risk of heart attacks and heart failure.

Last year, a team of researchers also reported on a study that suggested a possible "fix" for the side effects associated with COX-2 inhibitors.

The study found that the COX-2 enzyme is mostly found just in the brain, gut, kidney and thymus gland. 

Knowing this, researchers think that it may be possible to develop drugs that can specifically target these regions without affecting other parts of the body and causing serious side effects.

References:

1. American Academy of Neurology news release, accessed 4 November 2014.
2. Additional source: MedlinePlus, Stroke, accessed 4 November 2014.