What are the risks of long-term NSAIDs and COX-2 inhibitors?

This review presents an interesting new analysis of cyclo-oxygenase-2 (COX-2) inhibitor safety, concluding that long-term use results in more serious adverse events than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). The nonsystematic and retrospective properties of this analysis limit its validity. However, the fact that an evaluation of long-term data found some small harm to COX-2 inhibitors relative to traditional NSAIDs (number needed to harm=78 over 9 months) should give clinicians pause. Until better meta-analyses or new safety data are published, clinicians should prescribe COX-2 inhibitors long-term only for those patients deemed to be at high risk of ulcer complications.