Six RCTs with a total of 12,780 patients were included in the review.
Quality.
None of the studies was either adequately powered or specifically designed to assess the risk of cardiovascular thromboembolic events with celecoxib treatment. None of the studies reported systematic monitoring for cardiovascular events, and few studies reported that cardiovascular data were examined by a blinded external reviewer. The authors also stated that they found discrepancies in the reporting of the cardiovascular events in various publications of one of the included studies.
MI.
Four studies (n=4,422) compared celecoxib with placebo and assessed MI. The risk of MI was higher in the celecoxib groups, although of borderline statistical significance (pooled OR 2.26, 95% CI: 1.0, 5.1). Five studies (n=12,180) compared celecoxib with any other treatment and assessed MI. The risk of MI was significantly higher in the celecoxib groups (pooled OR 1.88, 95% CI: 1.15, 3.08).
Cerebrovascular events.
Four studies (n=4,422) compared celecoxib with placebo and assessed cerebrovascular events. There was no difference in the occurrence of cerebrovascular events between the groups (pooled OR 1.0, 95% CI: 0.51, 1.84). Six studies (n=12,780) compared celecoxib with any other treatment and assessed cerebrovascular events. Again there was no difference between the groups (pooled OR 0.73, 95% CI: 0.42, 1.26).
Cardiovascular mortality.
Three studies (n=4,021) compared celecoxib with placebo and assessed cardiovascular mortality. There was no difference in deaths from cardiovascular events between the groups (pooled OR 1.06, 95% CI: 0.38, 2.95). Five studies (n=11,989) compared celecoxib with any other treatment and assessed cardiovascular mortality. Again there was no difference between the groups (pooled OR 1.02, 95% CI: 0.52, 1.99).
Composite cardiovascular events.
Four studies (n=4,422) compared celecoxib with placebo and assessed composite cardiovascular events. These occurred more often in the celecoxib groups, but there was no significant difference between the groups (pooled OR 1.38, 95% CI: 0.91, 2.10). Six studies (n=12,780) compared celecoxib with any other treatment and assessed composite cardiovascular events. These occurred more often in the celecoxib groups, but again there was no significant difference between the groups (pooled OR 1.22, 95% CI: 0.92, 1.62).