A Systematic Review And Meta-analysis Of Cardiovascular Safety Of Celecoxib

Objective:To determine whether the cyclooxygenase-2 selective inhi-bitor celecoxib associated with an increased risk of cardiovascular events.Methods:Relevant randomized controlled trials(RCTs)of celecoxib were collected in databases including Pub Med,EMbase,Web of Science,The Cochrane Libra-ry,CBM and WanFang Data from inception to November 2016,and reference-s of the included articles,relevant files of the United States Food and Drug Administration and conference literature of the European Society of Cardiology(ESC)2015 Congress were also retrieved.Two reviewers independently screene-d literature according to the inclusion and exclusion criteria,extracted data an-d assessed the quality of the included studies.Then,meta-analysis was perform-ed using Review Manager 5.3 software.Results:A total of 7 RCTs involving 58744 patients were included.The results ofmeta-analysis show that,there were no significant differences in the incidence of composite cardiovascular events,myocardial infarction,cardiovascular death and stroke between the celecoxib group and the placebo group(all P>0.05).Compared with the nonselective NSAIDs group,the incidence of composite cardiovascular events,myocardial infarction,cardiovascular death and stroke in the celecoxib group was lower,although the differences were not significant.For patients taking aspirin,the incidence of composite cardiovascular events in the celecoxib group was higher than that in the placebo group,although there was no significant difference(2.73% vs 1.85%;relat-ive risk,1.36;95% confidence interval,0.94 to 1.97;P = 0.11).For patients not taking aspirin,the incidence of composite cardiovascular events in the celecoxi-b was higher than that in the placebo group(3.83% vs 2.23%;relative risk,1.58;95% confidence interval,1.13 to 2.21;P=0.008).Conclusion:On the basis of our meta-analysis,we can state that long-term treatment with celecoxib may be associated with an increased risk of cardiovascular events.And there was n-o difference in the rate of cardiovascular events between celecoxib treatment and nonselective NSAIDs.Because of the quality limitation and sampling size o-f the included studies,this conclusion still needs to be further proved by more prospective,high quality,large-scale and multicenter randomized controlled trials.