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LETTER
Year : 2009  |  Volume : 55  |  Issue : 1  |  Page : 73

Comment on: Nimesulide and adverse drug reactions: Time for a database


Department of Internal Medicine, Clinica San Gaudenzio, Via Bottini 3, Novara 28100, Italy

Correspondence Address:
F Bissoli
Department of Internal Medicine, Clinica San Gaudenzio, Via Bottini 3, Novara 28100
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.48446

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How to cite this article:
Bissoli F. Comment on: Nimesulide and adverse drug reactions: Time for a database. J Postgrad Med 2009;55:73

How to cite this URL:
Bissoli F. Comment on: Nimesulide and adverse drug reactions: Time for a database. J Postgrad Med [serial online] 2009 [cited 2019 Dec 11];55:73. Available from: http://www.jpgmonline.com/text.asp?2009/55/1/73/48446


Sir,

I agree with Dr. Khan on the interest of a recently reported case of hepatitis and toxic epidermal necrolysis linked to nimesulide use, considering that apparently no case of this association has been previously published. [1],[2] In fact, spontaneous reports of adverse drug events are helpful warning signals of rare toxicities.

It is to be, however, underlined that spontaneous reports do not allow us to determine incidences or relative risks, and can lead to spurious and potentially misleading conclusions. [3],[4],[5] More meaningful data may be obtained from population-based epidemiological studies reporting on the incidence or comparative risk of hospitalization and/ or death. [3] Based on such studies, the risk of serious liver injury due to the use of NSAIDs is quite low. [3] Although NSAIDs are cited as a common cause of liver damage, the apparently high "incidence" of NSAID-induced liver injury, reflects a much frequent use of these medications in the general population. [6] Very few fatal cases related to NSAID use have been reported, suggesting that the mortality rate is likely to be lower than 1/100,000 patient-years. [3]

The largest epidemiological population-based study (almost two million prescriptions) specifically focused on nimesulide vs. other NSAIDs, demonstrated for this NSAID only a small risk of hospitalization for acute liver injury, without cases of transplantation or death due to liver damage. [7] The European Medicine Agency (EMEA) has recently confirmed that the occurrence of serious hepatic adverse reactions following nimesulide use is very rare, and that the drug's benefit/risk profile is positive. [8] Regarding pediatric use of nimesulide, its administration is contraindicated in children below 12 years. These observations could help mitigate the concerns expressed about nimesulide. Obviously population-based studies need to be carried out in India for proper assessment.

It also needs to be clarified that the original Marketing Authorization Holder years ago decided to withdraw from the registration process of nimesulide in Australia and New Zealand and not to require its registration in the US and Canada only for commercial reasons (nimesulide was an out-of-patent drug and therefore open to generic competition), not for safety problems. [9]

 
 :: References Top

1.Chatterjee S, Pal J, Biswas N. Nimesulide-induced hepatitis and toxic epidermal necrolysis. J Postgrad Med 2008;54:150-1.  Back to cited text no. 1  [PUBMED]  Medknow Journal
2.Khan S. Nimesulide and adverse drug reactions: Time for a database. J Postgrad Med 2008;54:242.  Back to cited text no. 2  [PUBMED]  Medknow Journal
3.Rubenstein JH, Laine L. The hepatotoxicity of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2004;20:373-80.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Miwa LJ, Jones JK, Pathiyal A, Hatoum H. Value of epidemiologic studies in determining the true incidence of adverse events: The nonsteroidal anti-inflammatory drug story. Arch Intern Med 1997;157:2129-36.  Back to cited text no. 4  [PUBMED]  
5.Aithal GP, Day CP. Nonsteroidal anti-inflammatory drug-induced hepatotoxicity. Clin Liver Dis 2007;11:563-75.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Hussaini SH, Farrington EA. Idiosyncratic drug-induced liver injury: An overview. Expert Opin Drug Saf 2007;6:673-84.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Traversa G, Bianchi C, Da Cas R, Abraha I, Menniti-Ippolito F, Venegoni M. Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs. BMJ 2003;327:18-22  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Press Release post Hearing. [cited on 2007]. Available from: http://www.emea.europa.eu/pdfs/general/direct/pr/43260407en.pdf.  Back to cited text no. 8    
9.Bissoli F. Comment on: Nimesulide-induced hepatotoxicity and fatal hepatic failure. Singapore Med J 2008;49:436-7;Author reply 438.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]



This article has been cited by
1 Current awareness: Pharmacoepidemiology and drug safety
Pharmacoepidemiology and Drug Safety. 2009; 18(9): i
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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
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