Are selective COX 2 inhibitors superior to traditional NSAIDs?

doi:10.1136/bmj.325.7356.161

BMJ 2002;325:161 ( 20 July )

Letters

Are selective COX 2 inhibitors superior to traditional NSAIDs?

Rofecoxib did not provide unequivocal benefit over traditional NSAIDs

Pharmacia's response to editorial

Little is known about COX 2 inhibitors

Both the CLASS and VIGOR trials support the COX 2 hypothesis

Authors' reply

Rofecoxib did not provide unequivocal benefit over traditional NSAIDs

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

EDITOR $---$ In their editorial Jüni et al say that celecoxib is no safer than diclofenac or ibuprofen and that the CLASS authors"spun" their analysis to suggest otherwise.¹ They also state:"In contrast with the CLASS trial, the VIGOR trial, which wassimilar in design and outcomes, found an unequivocal benefit ofanother selective COX 2 inhibitor, rofecoxib, over traditionalnon-steroidal anti-inflammatory agents [NSAIDs]."²

I disagree. Although serious gastrointestinal adverse effects were less frequent in rofecoxib users than in patients withrheumatoid arthritis treated with naproxen (number needed to treatto prevent one serious upper gastrointestinal event 191; 95% confidenceinterval 114 to 586), rofecoxib was in fact less safe than naproxen.The published version of the VIGOR trial focused on the narrowoutcome of serious gastrointestinalcomplications.

The US Food and Drug Administration took the unprecedented step of presenting its review of both the CLASS trial and the VIGORtrial . . . [Full text of this article]

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