Cardiovascular Diseases Clinical Trial
Official title:
NSAIDs vs. Coxibs in the Presence of Aspirin: Effects on Platelet Function, Endothelial Function, and Biomarkers of Inflammation in Subjects With Rheumatoid Arthritis and Increased Cardiovascular Risk or Cardiovascular Disease
The objectives of this single site, randomized, crossover study is to evaluate the pharmacodynamic interactions between aspirin, NSAIDs and Coxibs with respect to platelet function, biomarkers of inflammation and endothelial function.
The relative cardiovascular safety of NSAIDs, particularly among patients with cardiovascular
disease (CVD) or at higher CVD risk, has generated considerable concern among both patients
and physicians because of knowledge gaps in the evidence relative to comparative safety and
pharmacodynamic interactions between aspirin and NSAIDs. In the recently reported PRECISION
trial, a moderate dose of celecoxib was found to be noninferior to ibuprofen or naproxen with
respect to cardiovascular safety in patients with arthritis at increased CVD risk. At this
time, no comparative prior data are available analyzing the effects of NSAIDs vs. Coxibs in
the presence of aspirin on platelet function, biomarkers of inflammation and endothelial
function.
Thirty patients with rheumatoid arthritis who are at high cardiovascular (CV) risk or with
established CV disease will be enrolled in the study. Patients taking anticoagulant therapy
or any other antiplatelet agent other than aspirin will be excluded.
Patients will be treated with immediate release 81mg aspirin for 4 weeks in the run-in period
followed by randomization to celecoxib (200 mg bid) vs. naproxen sodium (550 mg bid) for 4
weeks and then cross over to the other drug for another 4 weeks. Blood and urine samples will
be collected at baseline before the aspirin run in period, 24±4 hr after the last dose of
aspirin in the run in period, 24±4 hr after the last dose of the first period study drug and
24±4 hr after the last dose of the second period study drug. Assays for platelet function,
biomarkers of inflammation and endothelial function will be performed at these time points.
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