Lancet 18 Nov 2006

Two years ago, we were all rather shocked when the COX-2 specific drug rofecoxib was accused of increasing cardiovascular risk. There has been a flurry of reviews and meta-analyses since then, to which this study (MEDAL) comes as an afterword, confirming what we already know. It finds that etoricoxib and diclofenac at usual dosage carry about the same added risk (about 30%) of stroke, myocardial infarction and peripheral artery occlusion, but GI bleeds are less common with etoricoxib. The accompanying editorial is a reasonable summary of our knowledge to date, and reading it I wonder if most of our long term NSAID-taking patients wouldn’t be better off taking naproxen, which is cheap, effective and carries no cardiovascular risk, though many might also need to take a proton pump inhibitor.

An intelligent young patient of mine has just been given a diagnosis of retinitis pigmentosa, specifically due to Usher’s syndrome type II. Naturally, having looked them up on Google, she now knows a lot more about these conditions than I do. But if I want to try and get ahead of her, this is the place to look: a fantastically thorough summary of current knowledge (264 references), ending with a lengthy section on possible future treatments.