COX-2 inhibitors and type 4 error

• Published in: Canadian Medical Association journal (CMAJ) Vol. 169; no. 3; p. 190
• Main Authors: Pijak, Michal R, Gazdik, Frantisek
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact, Inc 05.08.2003
• Subjects: Cyclooxygenase Inhibitors - therapeutic use; Drugs; Humans; Letters; Physiological aspects; Review Literature as Topic; Risk Assessment; Systematic review
• ISSN: 0820-3946; 1488-2329

Concerns about the possibility of type 4 error in this case are reinforced by a summary of the Wright article published recently in BMJ,4 which states that "This is an excellent (although non-systematic) review of the benefits and harms of COX-2 inhibitors." It has been overlooked that Wright, in disregarding systematic reviews and meta-analyses on COX-2 inhibitors, has missed a large body of relevant evidence, including differences between individual NSAIDs.5-8 Before the publication of Wright's article, several other authors presented critical views regarding the cardiovascular safety of COX-2 inhibitors under the guise of scientific objectivity.9-11 Some argued that use of acetylsalicylic acid (ASA) might change the cost-effectiveness of COX-2 inhibition by reducing gastrointestinal benefit; hence, there would be no justification for prescribing a more expensive therapy.11 However, these authors overlooked the benefits of the combination of ASA and COX-2 inhibition relative to lessexpensive options such as ASA combined with a non-ASA NSAID or a non-ASA NSAID alone. These benefits include better gastrointestinal tolerability, sustained inhibition of platelet aggregation and freedom in the dosing regimen.12