The influence of celecoxib on muscle fatigue resistance and mobility in elderly patients with inflammation.
BACKGROUND
Acute inflammation has a negative effect on the muscular system in elderly patients, compromising the outcome of the underlying disease.


OBJECTIVE
The aim of this study was to evaluate the effect of cyclooxygenase-2 (COX-2) inhibition on muscle performance and mobility in hospitalized elderly patients with acute inflammation of infectious origin.


METHODS
In this single-blind, controlled trial, consecutively hospitalized elderly patients (age > or = 70 years) with inflammation (C-reactive protein [CRP] levels > or =10 mg/L) due to acute infection were randomly assigned to receive 2 weeks of treatment with the COX-2-selective inhibitor celecoxib, acetaminophen, or no supplementary medication (control). The following variables were assessed at baseline and at 1 and 2 weeks' follow-up: muscle fatigue resistance (primary outcome measure); grip strength and mobility (secondary outcome measures); and levels of the acute-phase markers CRP, interleukin (IL)-1beta, IL-6, IL-10, tumor necrosis factor-alpha (TNF-alpha), and transforming growth factor-beta (TGF-beta) as explanatory variables.


RESULTS
Forty-three consecutively hospitalized elderly patients (31 women, 12 men; mean [SD] age, 84 [6] years) were enrolled. Fourteen patients received celecoxib, 14 received acetaminophen, and 15 received no supplementary medication. The change in fatigue resistance was significantly different between groups (P = 0.021, Kruskal-Wallis chi-square test), with significantly greater improvement in patients receiving celecoxib compared with the acetaminophen and control groups (63% increase from baseline; P < 0.05). There were no significant between-group differences in changes in grip strength, mobility, IL-1beta, IL-6, TNF-alpha, or TGF-beta. The changes in levels of IL-10 differed significantly between groups (P = 0.020, Kruskal-Wallis chi-square test), with greater improvement in the celecoxib group compared with the acetaminophen group (P = 0.032).


CONCLUSIONS
The results of this study suggest that COX-2-selective inhibition has a beneficial effect on muscle fatigue resistance in hospitalized elderly patients with acute inflammation of infectious origin. However, until further trials are conducted, the use of COX-2-selective inhibitors for this indication is not recommended.
Mets
Tony
T
Gerontology Unit, Free University of Brussels (VUB), Academic Hospital, Belgium. tony.mets@az.vub.ac.be
Bautmans
Ivan
I
Njemini
Rose
R
Lambert
Margareta
M
Demanet
Christian
C
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D018737:Hand Strength; D006801:Humans; D007239:Infections / Q000150:complications / Q000503:physiopathology; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D008297:Male; D009068:Movement / Q000187:drug effects*; D018763:Muscle Fatigue / Q000187:drug effects*; D011720:Pyrazoles / Q000627:therapeutic use*; D016037:Single-Blind Method; D013449:Sulfonamides / Q000627:therapeutic use*
D016861:Cyclooxygenase Inhibitors; D016207:Cytokines; D011720:Pyrazoles; D013449:Sulfonamides; D002097:C-Reactive Protein; D000068579:Celecoxib