Nephrotoxic potential of selective cyclooxygenase-2 inhibitors.
OBJECTIVE
To determine the relative nephrotoxic potential of cyclooxygenase (COX)-2 inhibitors.


METHODS
A MEDLINE search (1996-February 2004) identified clinical trials evaluating the nephrotoxicity of COX-2 inhibitors versus traditional nonsteroidal antiinflammatory drugs (NSAIDs). Key search terms included cyclooxygenase inhibitors, nonsteroidal antiinflammatory agents, nephrotoxicity, and chemically induced.


RESULTS
Three clinical trials determined that COX-2 inhibitors have similar adverse effects on the kidney when compared with nonselective NSAIDs, while 2 studies concluded that COX-2 inhibitors are less nephrotoxic than nonselective NSAIDs. All 5 trials utilized low numbers of subjects, short-term therapy, and surrogate markers of kidney damage.


CONCLUSIONS
COX-2 inhibitors may not offer distinct advantages over nonselective NSAIDs with respect to kidney function. Longer trials in patients with comorbidities are warranted. These agents should be used cautiously or not at all in patients with predisposing conditions.
College of Pharmacy, Idaho State University, Pocatello, ID 83209-8356, USA.
Gurbir K
GK
Sandhu
Catherine A
CA
Heyneman
D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D007674:Kidney Diseases / Q000139:chemically induced*; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases