Abstract and Introduction
Abstract
In this issue of the Journal, Wei et al. (Am J Epidemiol. 2023;192(9):1432–1448); demonstrate the modification of effect of nonselective nonsteroidal antiinflammatory drugs in the setting of aspirin use for the outcome of cardiovascular events. This study is distinctive in its aim to compare 2 similar therapies in the setting of 2 clinical scenarios (aspirin use vs. not) based on some mechanistic rationale. The use of an active comparator design with a prehypothesized evaluation of treatment heterogeneity can provide compelling evidence to support relevant clinical decisions for which clinical trial evidence is not likely or possible.
Introduction
One of the greatest fears for practicing clinicians is the lack of certainty regarding long-term risks of rare events among patients taking commonly prescribed therapies. Perhaps none is more commonly discussed than nonsteroidal antiinflammatory drugs (NSAIDs), which rank among the most commonly used pharmacological therapies for osteoarthritis as well as other chronic pain and inflammatory conditions. These therapies are inexpensive and have been shown to be effective at reducing pain in osteoarthritis.[1] While use of drugs from this therapeutic class is considered to raise the risk of adverse cardiovascular events, the magnitude of effect is low and thus most patients are likely to benefit without suffering harm.[2] Because therapies for osteoarthritis are limited, it may be necessary to accept some risk in order to adequately manage the symptoms of the condition.
Am J Epidemiol. 2023;192(9):1449-1451. © 2023 Oxford University Press
