Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets because of cardiovascular toxicity, and should be removed from the Essential Medicines Lists of countries globally, a study concluded.
Researchers conducted a meta-analysis of the relative risks of cardiovascular events with non-steroidal anti-inflammatory drugs (NSAIDs). They then examined the Essential Medicines Lists and market shares for NSAIDs in countries around the world
Results appeared at PloS Medicine.
Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk.
Listing of individual NSAIDs on Essential Medicines Lists and NSAID sales or prescription data showed that diclofenac was listed on 74 countries' Essential Medicines Lists, naproxen on just 27. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%; range 14.7 to 58.7%). Rofecoxib was not being used any more in any country following its market withdrawal eight years ago.
Diclofenac was the most commonly used NSAID, with an average market share across the 15 countries of nearly 30%, or close to that of the next three most popular drugs combined. By contrast, naproxen had an average market share of less than 10%. Finally, across both high- and low-/middle-income countries, diclofenac and etoricoxib accounted for one-third of total NSAID usage.
An editorial noted that while it is the responsibility of government agencies to update regulations and marketing approvals for drugs distributed in their respective jurisdictions, there is also a responsibility on the part of physicians to stay current on clinical knowledge.
They wrote, "While there is usually a time lag between scientific publications and translation of that knowledge into improved practice patterns, the internet should hasten the diffusion of knowledge. Cardiologists and neurologists too should play a greater role by becoming better informed of the adverse effects, disseminating evidence-based recommendations on the risks associated with different NSAIDs to other physicians, and strongly advocating for stricter regulation of NSAIDs with a harmful cardiovascular profile."