BMJ 2002;325:607-608 ( 21 September )

Editorials

Efficacy and safety of COX 2 inhibitors

New data are encouraging but the risk:benefit ratio remains unclear

Papers pp 619, 624

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

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and improve function in people with mechanical and inflammatory arthropathies and are beneficial in many other conditions, but these benefits come at a price. In the United Kingdom, every year over 2000 people die as a result of upper gastrointestinal damage induced by NSAIDs, and these agents can also have unwanted effects on the lower bowel, lungs, kidneys, and cardiovascular system. Conversely, some NSAIDs may have useful antithrombotic actions and increasing evidence shows that they may inhibit the development of colonic neoplasia and other gastrointestinal cancers.^1-3 The introduction of new anti-inflammatory agents, with more specific inhibitory effects on cyclo-oxygenase 2 (COX 2) pathways, promised equivalent efficacy with greater safety and tolerability.

Two large pivotal trials have been published, in which the efficacy and safety of the COX 2 inhibitors celecoxib and rofecoxib were compared with various traditional NSAIDs. Unfortunately the celecoxib long term arthritis safety study (CLASS),⁴ . . . [Full text of this article]

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This article has been cited by other articles:

• Sooriakumaran, P (2006). COX-2 inhibitors and the heart: are all coxibs the same?. Postgrad. Med. J. 82: 242-245 [Abstract] [Full text]  
• Lewis, M. R, Kay, D. (2005). Risk of gastrointestinal effects with COX-2 inhibitors and NSAIDs: COX-2 inhibitors were thought of as a safe option. BMJ 331: 1474-1474 [Full text]  
• Hippisley-Cox, J., Coupland, C., Logan, R. (2005). Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 331: 1310-1316 [Abstract] [Full text]  
• Hippisley-Cox, J., Coupland, C. (2005). Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 330: 1366- [Abstract] [Full text]  
• Kazanov, D., Dvory-Sobol, H., Pick, M., Liberman, E., Strier, L., Choen-Noyman, E., Deutsch, V., Kunik, T., Arber, N. (2004). Celecoxib But Not Rofecoxib Inhibits the Growth of Transformed Cells in Vitro. Clin. Cancer Res. 10: 267-271 [Abstract] [Full text]  
• Juni, P., Sterchi, R., Dieppe, P., Metcalfe, S., Dougherty, S., McNee, W., Deeks, J. J, Smith, L. A, Bradley, M. D (2003). Systematic review of celecoxib for osteoarthritis and rheumatoid arthritis. BMJ 326: 334-334 [Full text]  
• (2002). Celecoxib: Equally Efficacious, Less GI Toxic Than Other NSAIDs. Journal Watch Dermatology 2002: 9-9 [Full text]  
• (2002). Celecoxib: Equally Efficacious, Less GI Toxic Than Other NSAIDs. JWatch General 2002: 3-3 [Full text]  

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