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COX-2-Selective NSAIDs and Risk of Hip or Knee Replacements: A Population-Based Case–Control Study

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Abstract

Disease models of osteoarthritis (OA) have shown that COX-2-selective nonsteroidal anti-inflammatory drugs (NSAIDs, coxibs) may have beneficial effects on cartilage. Clinical or epidemiological evidence for this potential association is scarce. The objective of this study was to evaluate the risk of hip or knee replacement in users of coxibs compared to nonselective NSAIDs. A population-based case–control study was conducted with the Dutch PHARMO Record Linkage System. Cases (n = 26,202) had a first replacement of the hip or knee after enrollment (2000–2009). Up to two controls (without hip or knee replacement) were matched by year of birth, gender, healthcare region, and calendar year. Using conditional logistic regression analysis, odds ratios (ORs) for hip or knee replacement were estimated by comparing long-term (≥1 year) nonselective NSAID use with long-term coxib use. Analyses were statistically adjusted for disease and drug history. Long-term use of nonselective NSAIDs was not associated with a different risk of hip replacement (adjusted OR = 0.89, 95 % CI 0.65–1.22) or knee replacement (adjusted OR = 0.74, 95 % CI 0.49–1.11) as compared to long-term coxib use. Results were not different after stratification by gender, age, and cardiovascular or gastrointestinal disease. This study shows that long-term users of nonselective NSAIDs do not have a different risk of hip or knee replacement as compared to long-term coxib users. Therefore, our results do not support that patients with OA could benefit from using coxibs in order to slow progression of this disease.

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Acknowledgments

The Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, has received unrestricted research funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the privately–publicly funded Top Institute Pharma (www.tipharma.nl, includes cofunding from universities, government, and industry), the EU Innovative Medicines Initiative (IMI), the EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, and the Dutch Ministry of Health and Industry (including GlaxoSmithKline, Pfizer, and others).

Conflict of interest

The authors have stated that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands

    Corinne Klop, Frank de Vries, Arief Lalmohamed & Hubert G. M. Leufkens

  2. MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK

    Frank de Vries

  3. Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Frank de Vries

  4. Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands

    Simon C. Mastbergen, Willemijn H. Noort-van der Laan, Johannes W. J. Bijlsma & Paco M. J. Welsing

  5. Department of Rheumatology, Maartenskliniek, Woerden, The Netherlands

    Willemijn H. Noort-van der Laan

  6. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    Paco M. J. Welsing

  7. Maastricht University/CAPHRI, Maastricht, The Netherlands

    Frank de Vries

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  1. Corinne Klop
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Correspondence to Frank de Vries.

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Klop, C., de Vries, F., Lalmohamed, A. et al. COX-2-Selective NSAIDs and Risk of Hip or Knee Replacements: A Population-Based Case–Control Study. Calcif Tissue Int 91, 387–394 (2012). https://doi.org/10.1007/s00223-012-9646-x

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  • DOI: https://doi.org/10.1007/s00223-012-9646-x

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