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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents the results of the cardiovascular outcomes Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) program. The MEDAL program consisted of pooled data from three trials conducted at 1380 sites in 46 countries: the EDGE trial (osteoarthritis, 7111 patients), the EDGE II trial (rheumatoid arthritis, 4,086 patients), and the MEDAL trial (osteoarthritis and rheumatoid arthritis, 23,504 patients). The goal of this program was to determine whether cardiovascular event rates were similar in patients treated daily with a COX-2 inhibitor (etoricoxib) compared with those treated with a widely used traditional NSAID (diclofenac).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Earthritis clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erheumatoid arthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einflammatory disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EChristopher P. Cannon, MD, Brigham and Women\u0027s Hospital, Boston presented the results of the cardiovascular outcomes Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) program. The MEDAL program consisted of pooled data from three trials conducted at 1,380 sites in 46 countries: the EDGE trial (osteoarthritis, 7,111 patients), the EDGE II trial (rheumatoid arthritis, 4,086 patients), and the MEDAL trial (osteoarthritis and rheumatoid arthritis, 23,504 patients). The goal of this program was to determine whether cardiovascular event rates were similar in patients treated daily with a COX-2 inhibitor (etoricoxib) compared with those treated with a widely used traditional NSAID (diclofenac). Patients over 50 years of age with a diagnosis of either rheumatoid arthritis (RA) or osteoarthritis (OA) of the hand, hip, knee, or spine were eligible for participation. Patients meeting all eligibility criteria were randomized either to etoricoxib (60 or 90 mg\/day for OA or 90 mg\/day for RA) or diclofenac (150mg\/day).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EA total of 34,701 patients were enrolled in the program, 17,412 in the etoricoxib group and 17,289 in the diclofenac group. The mean (SD) duration of therapy was 18.2 months (11.7) for etoricoxib and 17.7 (11.9) months for diclofenac. The demographic characteristics were similar between the two treatment groups. \u201cOver the three year period that the patients were followed, there was no difference over time in the risk of [cardiac] events with these two different agents\u201d said Dr. Cannon. The primary outcome measure of thrombotic cardiovascular event rates had a hazard ratio (HR) of 0.95 [95% CI, 0.81\u20131.11].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10903\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10903\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10903\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESubgroup analyses were also performed and revealed no differences between treatments when factors such as age, gender, diabetes, established atherosclerotic cardiovascular disease (ASCVD), established ASCVD or \u2265 2 risk factors, low-dose aspirin usage, type of arthritis, or etoricoxib dose were examined. Rates of upper gastrointestinal tract events were significantly lower with etoricoxib (HR=0.69; [95% CI, 0.57\u20130.83]).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003E\u201cObservational studies may lead us astray\u201d in making therapeutic decisions, said Dr. Cannon, emphasizing the importance of controlled, randomized trials such as those in the MEDAL program. Other questions regarding cardiovascular events and the use of these medications remain unanswered, as this study had only one comparator and many others agents are routinely utilized. The choice of diclofenac as the comparator has also been criticized. \u201cThe investigators are justified in saying diclofenac is the most widely used traditional NSAID on the market worldwide and therefore it\u0027s a worthy competitor in a head-to-head comparison\u201d, said Robert M. Califf MD of Duke University in his discussion of the trial data. He noted, however, that \u201cthis leaves open whether naproxen is actually cardio protective and would have come out significantly better than the COX-2 specific drug. It also leaves open the 10\u201320 other potential comparisons one can make.\u201d For now, clinicians must continue to tailor arthritis pain pharmacotherapy after considering the needs, history, and risks of each individual patient. The results of this study were published online in \u003Cem\u003EThe Lancet\u003C\/em\u003E on November 13, 2006 (Cannon et al, \u003Ca href=\u0022http:\/\/www.thelancet.com\u0022\u003Ewww.thelancet.com\u003C\/a\u003E; DOI: 10.1016\/S0140-6736(06)69666\u20139).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/5\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm4g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm4g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}