Cardiovascular safety profile of repeated etoricoxib courses in gout

I.Z. Gaidukova^1,2, V.I. Mazurov^1,2, A.Yu. Fonturenko^1,2, R.A. Bashkinov^1,2, M.S. Petrova^1,2, O.V. Inamova^1,2, A.A. Shapovalov³, I.M. Nagirnyak³

¹North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg

²Clinical Rheumatological Hospital No. 25, Saint-Petersburg

³TechLAB LLC, Saint-Petersburg

Background: non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat gout attacks in short courses. Repeated courses of NSAIDs are prescribed for chronic or recurrent gout, which leads to an increase in the total dose and duration of course, changing the safety profile of treatment.

Aim: to study the incidence of myocardial infarction (MI), arterial hypertension (AH), and chronic kidney disease (CKD) in patients with chronic or recurrent gout with repeated courses of etoricoxib (EC).

Patients and Methods: an analysis of the features of EC use in patients with gout was performed based on the data of the Saint Petersburg city register of gout and asymptomatic hyperuricemia from 2000 to 2019, formed on the basis of the GALENOS cloud electronic data storage system (Techlab LLC).

Results: the register included data of 1,725 patien ts with gout, of whom 315 people took EC and 118 had repeated courses (average age 57.1±7.9 years; 43 women). Age-and gender-matched patients with gout who received other NSAIDs in repeated courses (n=60) made up the control group. The follow-up period averaged 4.85±3.36 (1–17) years. The average duration of EC treatment was 24.9±15.2 (8–87) days, and other NSAIDs-37.1±9.8 (21–74) days (p<0.0001). The NSAID intake index (Dugados Functional Index) for EC was equal to 6.8%, for other NSAIDs — 10.2% (p<0.05). The average dosage of EC was 92.3±16.8 (60–120) mg/day. During follow-up, 7 (3.9%) patients were diagnosed with AH, 45 (25.3%) with CKD, and 2 (1.7%) patients had MI. The occurrence of cardiovascular diseases was more commonly detected in patients who alternated EC with other NSAIDs, versus patients who received EC or other NSAIDs without switching, and versus population indicators (p<0.05 for all comparisons).

Conclusion: the use of repeated EC courses of for the treatment of chronic or recurrent gout is not associated with an increase in the risk of MI, hypertension, or CKD, provided that EC is not switched to other NSAIDs, since in this case the shortest duration of administration and the total dose of NSAIDs are achieved.

Keywords: gout, chronic inflammation, cardiovascu lar safety profile, non-steroidal anti-inflammatory drugs, coxibs.

For citation: Gaidukova I.Z., Mazurov V.I., Fonturenko A.Yu. et al. Cardiovascular safety profile of repeated etoricoxib courses in gout. RMJ. 2020;11:54–58.