To the Editor: Dr Silverstein and colleagues1 suggest that celecoxib appears to be associated
with significantly less renal toxicity than therapy with NSAIDs, as do Drs
Lichtenstein and Wolfe2 in their Editorial.
It is possible, however, that particular NSAIDs have worse outcomes than nonselective
NSAIDs and celecoxib. If so, it would be more appropriate to examine reasons
for such a finding (eg, concurrent drug regimens that could potentiate renal
toxicity of NSAIDs), rather than conclude that celecoxib had a lower rate
of renal adverse events than did all nonselective NSAIDs. It is similarly
possible that the rates of GI ulcers and ulcer complications could have been
influenced by a particular subgroup.
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