Efficacy and safety of COX 2 inhibitors

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

Papers pp 619, 624

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 in which celecoxib was compared with ibuprofen and …