Life without COX 2 inhibitors

doi:10.1136/bmj.332.7553.1287

BMJ 2006;332:1287-1288 (3 June), doi:10.1136/bmj.332.7553.1287

Editorial

Life without COX 2 inhibitors

Doctors need to broaden their approach to pain in older patients

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

Several cyclo-oxygenase-2 inhibitors (COX 2 inhibitors) havebeen withdrawn from sale in many countries. The use of otherdrugs in this class is being limited by their potential to causecardiac effects. As Kearney and colleagues show (p 1302), thisconcern is valid, since they have been associated with an increasedrisk of myocardial infarction with prolonged use as comparedwith placebo or other non-steroidal anti-inflammatory drugs.¹

Have we lost a truly superior option? Probably not. AlthoughCOX 2 inhibitors were marketed as being less likely to causegastrointestinal distress and ulceration, there is good evidencethat other pharmacological and non-drug options may be reasonablyeffective, equally safe, and less costly.

COX 2 inhibitors rose to market prominence on the basis of premarketingand postmarketing studies showing less ulceration, on endoscopy,of the gastrointestinal tract. However, ulceration is neitherintrinsically harmful nor a surrogate marker for harm . . . [Full text of this article]

Allen F Shaughnessy, adjunct professor of public health and family medicine

Tufts University Family Medicine Residency, 100 Hospital Road, Malden, MA 02148, USA
(Allen.Shaughnessy@Tufts.edu)

Andrea E Gordon, clinical assistant professor of public health and family medicine

Tufts University Family Medicine Residency, 100 Hospital Road, Malden, MA 02148, USA

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