Comparison of renal effects between celecoxib and naproxen in elderly patients at Rapavithi Hospital

Abstract

The purpose this study was to compare renal effects between celecoxib and naproxen. The study was conducted in fourty-eight elderly patients with musculoskeletal problems in Rheumatology Clinic at Rajavithi Hospital. Majority of patients in this study were hypertensive patients and/or renal insufficiency while minority of them were healthy. After 2 week wash out of any previous receiving NSAIDs, the patients were allocated to receive 500 mg twice daily dose of naproxen or 200 mg twice daily doses of celecoxib for 2 weeks and then crossover for another 2 weeks. The renal effects (creatinine clearance, serum creatinine, blood urea nitrogen, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, electrolyte, edema) and other adverse effects were monitored at the of each period. Celecoxib. 200 mg twice daily, and naproxen, 500 mg twice daily, had shown similar decrease of renal functions in all patients, hypertensive patients, normal renal and renal insufficiency patients. Renal function had a tendency to decline in hypertensive patients (either normal or insufficiency). Celecoxib 200 mg twice daily caused greater decrease in renal function than naproxen 500 mg twice daily in hypertensive patients (normal renal) but not statistical significance (p=0.075). Other factors (such as male gender, high uric acid level) did not relate to deterioration of renal function after naproxen and celecoxib use. Naproxen significantly increased systolic blood pressure in hypertensive patients (either treated or untreated hypertension) (p=0.004) while celecoxib did not significantly affect blood pressure in normal blood pressure patients and hypertensive patients. Neither naproxen nor celecoxib showed effect on serum electrolyte and electrolyte excretion in urine. Renal functions could return to baseline at the end of study when the drug was withdrawn . The occurrence of edema from naproxen was higher than that of celecoxib but not statistical significance (p=0.181). Edema in naproxen group relate to sodium retention and destabilization of systolic blood pressure. In addition, the occurrences of other adverse drug reaction from naproxen were higher than those of celecoxib but also not statistical significance (p=0.138). None of the patients developed serious adverse effects, vital sign and other laboratory abnormalities.