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Toxicity Risk Scores Assessed for NSAID Users

Arthritis Rheumatol; ePub 2019 Feb 23; Solomon, et al

Risk scores accurately categorize the 1‐year risk of major toxicity among non-steroidal anti-inflammatory drug (NSAID) users and may be useful in identifying rheumatology patients who can safely use these agents, according to a recent investigation. Patients with known cardiovascular disease (CVD) or cardiovascular risk factors who had osteoarthritis (OA) or rheumatoid arthritis (RA) were split into derivation and validation cohorts. Subjects were randomized to 3 different NSAIDs at typical dosages. The risk score predicted the 1‐year occurrence of major toxicity among NSAID users, including major adverse cardiovascular events, acute kidney injury, significant gastrointestinal events, and mortality. Researchers found:

  • In the derivation cohort, significant variables included age, male sex, history of CVD, hypertension, diabetes, tobacco use, statin use, elevated serum creatinine, hematocrit, and type of arthritis.
  • The C‐index was 0.73 in the validation cohort and 0.71 in the total cohort; the model was well-calibrated.
  • In the total population with complete data (n=23,735), 1,080 (4.6%) had predicted 1‐year risk <1%, 16,273 (68.6%) had predicted risk at 1‐4%, and 6,382 (26.9%) had predicted risk >4%.

Solomon DH, Shao M, Wolski K, Nissen S, Husni ME, Paynter N. Derivation and validation of a major toxicity risk score among NSAID users based on data from a randomized controlled trial. [Published online ahead of print February 23, 2019]. Arthritis Rheumatol. doi:10.1002/art.40870.