Potential alternatives to COX 2 inhibitors

doi:10.1136/bmj.324.7349.1289

BMJ 2002;324:1289-1290 ( 1 June )

Editorials

Potential alternatives to COX 2 inhibitors

New molecules may overtake the COX 2 inhibitors debate

The first 150 words of the full text of this article appear below.

For many years, non-steroidal anti-inflammatory drugs were regarded as a treatment for which there was no gain in arthritiswithout the pain of gastroduodenal toxicity. This reflected theunderstanding that non-steroidal anti-inflammatory drugs (NSAIDs)were cyclo-oxygenase inhibitors that reduced prostaglandin synthesisboth in inflamed joints with benefit and in the stomach with detriment(figure). Recognition that a highly inducible enzyme, cyclo-oxygenase-2,largely subserved the former and a constitutive enzyme, cyclo-oxygenase-1,the latter provided an obvious selective target. The consequentsuccess of cyclo-oxygenase-2 (COX 2) inhibitors arises, in part,from the conceptual simplicity of this idea. The journey fromconcept to reality has, however, inevitably been more complex,and one controversial issue is dealt with in an accompanying editorial.¹The failure of the celecoxib long term arthritis safety study(the CLASS study) may have more to do with the design of the trialthan with inadequacies of cyclo-oxygenase-2 inhibitors. Otherlimitations . . . [Full text of this article]