COX-2 inhibitors. What is their place?
BACKGROUND
Nonsteroid anti-inflammatory drugs (NSAIDs) are widely used in Australia for the treatment of arthritis and the relief of pain. However, side effects, particularly those affecting the gastrointestinal tract, are of considerable cost to the individual and the community.


OBJECTIVE
To examine the role of selective cyclo-oxygenase-2 (COX-2) inhibitors in the anti-inflammatory armamentarium.


CONCLUSIONS
COX-2 inhibitors are of similar clinical efficacy to nonselective NSAIDs. They cause significantly fewer endoscopic ulcers, but these lesions are usually clinically asymptomatic. Dyspepsia rates are 1-2% lower. The frequency of serious gastrointestinal complications (symptomatic ulceration, bleeding, perforation) appears to be reduced by 0.5-1.0%. As these problems occur infrequently, routine use of COX-2 inhibitors would not be cost effective. Although no data are yet available, patients at high risk of NSAID induced gastrointestinal complications may be the group for whom COX-2 inhibitors will provide most clinical benefit.
McGettigan
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Discipline of Clinical Pharmacology, University of Newcastle, New South Wales.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001315:Australia; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008565:Membrane Proteins; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism*; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases