Efficacy of the newest COX-2 selective inhibitors in rheumatic disease.
Non-steroidal antiinflammatory drugs (NSAIDs) are standard treatment for the pain and inflammation associated with arthritis. Traditional NSAIDs and cyclooxygenase-2 (COX-2) selective inhibitors exhibit comparable efficacy, with different safety profiles. Traditional NSAIDs are associated with an increased risk of serious gastrointestinal (GI) adverse events versus COX-2 selective inhibitors, and chronic use frequently necessitates adjunctive therapy with gastroprotective agents. COX-2 selective inhibitors are often used in preference to avoid these GI adverse events. Recent studies have raised the concern that COX-2 selective inhibitors and traditional NSAIDs appear to be associated with a higher incidence of thrombotic cardiovascular events versus placebo. The key in prescribing these agents is for the physician to take a proactive approach to patient management and evaluation of GI and cardiovascular risk factors. This review examines the role of the newest COX-2 selective inhibitors, etoricoxib and lumiracoxib, in treating rheumatic disease.
Baraf
Herbert S B
HS
The Center for Rheumatology & Bone Research, Wheaton, MD 20902 USA. hsbbaraf@mac.com
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D015210:Arthritis, Gouty / Q000188:drug therapy / Q000201:enzymology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000201:enzymology; D002318:Cardiovascular Diseases / Q000139:chemically induced; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004008:Diclofenac / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077613:Etoricoxib; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D008565:Membrane Proteins / Q000378:metabolism*; D010003:Osteoarthritis / Q000188:drug therapy / Q000201:enzymology; D018579:Patient Selection; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000201:enzymology; D018570:Risk Assessment; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000201:enzymology; D013450:Sulfones / Q000009:adverse effects / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D008565:Membrane Proteins; D011725:Pyridines; D013450:Sulfones; D004008:Diclofenac; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; C473384:lumiracoxib; D000077613:Etoricoxib