Use of often prescribed drugs against arthritis and pain increases the risk of dying from a stroke. This is the conclusion of a major new registry study involving more than 100,000 patients.

2014.11.13 | Lotte Fisker Jørgensen

It is older versions of COX-2 inhibitors, which are now linked to increased risk of dying from a stroke.

Each year 15,500 Danes suffer a stroke caused by a blood clot or bleeding in the brain. Many of them suffer permanent injury and 4,700 die each year due to strokes, which makes suffering a stroke the third most frequent cause of death in Denmark. New research from Aarhus University and Aarhus University Hospital has now documented that the use of a number of widespread Arthritis drugs increases the risk of dying from a stroke.

In the study researchers have taken a closer look at what are known as COX-2 inhibitors which are a special type of prescription-only arthritis medicine. They are found in both older and newer versions and are sold in Denmark under names such as Voltaren, Diclon and Todalac.

"Some of the newer types of COX-2 inhibitor medicines have already been removed from the shelves again due to the increased risk of heart attacks, but many of the older medicines are still being widely prescribed. Our study shows that the use of these arthritis drugs increases the risk of fatal strokes," says Clinical Associate Professor and MD Christian Fynbo Christiansen. He is behind the study together with colleagues from Aarhus University and Aarhus University Hospital.

Comprehensive study

The study, which is the largest so far in this area, included 100,243 Danish patients admitted after a first stroke between the years 2004-2012. The researchers compared the number of deaths during the first month with the patients' use of selected types of arthritis medicines within a two-month period prior to the stroke.

With the help of the Danish National Prescription Registries, the researchers were able to see whether the patients had never received the medicine, whether they were previous or current users of the medicine, and whether they were new users or had been taking the medicine for a long period of time.

Important knowledge

The researchers also analysed whether they were dealing with newer or older generations of COX-2 inhibitors.

"In general, patients who received COX-2 inhibitors at the time of hospitalisation had a 19 per cent greater risk of dying of a stroke compared to patients who did not receive the drug. A large part of this result is due to new users of COX-2 drugs who had an increased risk of suffering a fatal stroke that was 42 per cent higher," says Professor and Chair, Consultant Hans Erik Bøtker, who was also involved in the study.

"The proportion of patients who risk dying of a stroke is even higher when we only look at the older generation drugs. The study shows that it is particularly important to ensure that persons with an increased risk of suffering from a stroke are not prescribed this type of drug as long as there are other options," he adds.

He emphasises that, on the other hand, the survey did not show any correlation between the use of ordinary analgesics, non-selective NSAID drugs, and the risk of a fatal stroke.

The study has just been published in the recognised American journal Neurology. 

Facts about the study

• Of the 100,243 patients who participated, eleven per cent (10,835 patients) used an NSAID product, including COX-2 inhibitors.
• Of these, 51 per cent used ibuprofen and 27 per cent Voltaren.
• 8 per cent (8,402 patients) had previously used an NSAID product.
• 81 per cent of the patients did not take the medicine. 

Contact              

Christian Fynbo Christiansen, Specialty Registrar, Clinical Associate Professor, PhD
Aarhus University, Department of Clinical Medicine, Department of Clinical Epidemiology
Tel.: +45 8716 8218 / +45 2020 8398
cfc@clin.au.dk

Hans Erik Bøtker, Professor and Chair, Consultant, DMSC
Aarhus University, Department of Clinical Medicine and
Aarhus University Hospital, Department of Cardiology
Tel.: +45 7845 2026 / +45 4029 3389
heb@dadlnet.dk