Asthma and lower airway diseaseSafety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials
Section snippets
Methods
A systematic review of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases was performed with a prespecified protocol and search strategy (see Table E1, Table E2 in this article's Online Repository at www.jacionline.org) to identify all blinded, placebo-controlled clinical trials published on or before April 11, 2013, that evaluated the effects of acute oral selective NSAIDs (meloxicam, nimesulide, and nabumetone) or COX-2 inhibitor exposure (rofecoxib, celecoxib,
Results
Of 1604 references screened, 14 blinded, placebo-controlled clinical trials evaluating acute selective oral NSAID exposure in patients with AERD were included in the main analysis (Fig 1 and Table I16, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32). For selective NSAIDs or COX-2 inhibitors, 14 studies provided data on respiratory symptoms, 12 studies provided data on a decrease in FEV1 of 20% or greater, and 9 studies provided data on nasal symptoms. A total of 485 acute oral selective
Discussion
This study found no significant differences in adverse respiratory effects after acute exposure to COX-2 inhibitors and a small but statistically significant risk with selective NSAIDs in patients with AERD. Reactions to selective NSAIDs occurred in approximately 1 in 13 patients with AERD. Assuming a prevalence of AERD of 10%, this would equate to selective NSAIDs causing symptoms in approximately 0.8% of the general asthmatic population.
The selective NSAIDs evaluated are at least 10-fold more
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Supported by a Scottish Government Chief Scientist Office Clinical Academic Fellowship that provided support to D.R.M.
Disclosure of potential conflict of interest: D. R. Morales, B. Guthrie, C. Jackson, and V. H. Santiago have received research support from the Scottish Government Chief Scientist Office Clinical Academic Fellowship received by Dr Daniel Morales. B. J. Lipworth has received research support from the Scottish Government Chief Scientist Office Clinical Academic Fellowship received by Dr Daniel Morales, Chiesi, Teva, Pharmaxis, and Nycomed; has consultant arrangements with Gurnos, Chiesi, and Hexal; has received payment for lectures from Teva; and has received travel support from GlaxoSmithKline, Chiesi, and Pharmaxis. P. T. Donnan has received research support from the Scottish Government Chief Scientist Office Clinical Academic Fellowship received by Dr Daniel Morales, GlaxoSmithKline, Otsuka, and Amgen and has consultant arrangements with Scottish Medicines Consortium.