To the Editor: In the study by Dr Langman and
colleagues,1 data from several studies were
pooled prospectively, and the results were interpreted to indicate that "rofecoxib
was associated with a significantly lower incidence of PUBs [upper gastrointestinal
tract perforations, symptomatic gastroduodenal ulcers, and upper gastrointestinal
tract bleeding] than treatment with NSAIDs [nonsteroidal anti-inflammatory
drugs]." The consistent use of this terminology throughout the manuscript
implies that rofecoxib is not an NSAID (which it is) and that all of the drugs
to which it was compared belong to a class that is dissimilar to rofecoxib.
The latter conclusion cannot be supported from the data presented. The authors
did certain analyses and concluded that "a common RR [relative risk for the
comparators] was appropriate." The nonsignificant test for treatment by protocol
interaction cannot be taken as proof of homogeneity because this test has
very low power in the presence of so few events. Furthermore, with no PUBs
associated with 1 of the comparators, nabumetone, there is nothing to suggest
that the PUB rate of nabumetone is not as good as or better than that of rofecoxib.
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