Risk-benefit perspectives in COX-2 blockade.
The withdrawal of the celebrity arthritis drug, rofecoxib (Vioxx) has sparked an intense discussion and controversy about the safety of the selective COX-2 inhibitors. Laboratory, epidemiological, and clinical studies have surged and continued to evaluate and understand the safety of coxibs and traditional NSAIDs. This paper reviews the scientific and clinical basis of not only the risks, but also the benefits surrounding the use COX-2 inhibitors and NSAIDs. Discussion, debate, opinions, regulatory and clinical recommendations have evolved since the unexpected emergence of cardiac thrombotic events from the use of these drugs. The evidence by which coxibs and NSAIDs can potentially attenuate or exacerbate cardiovascular disease by affecting endothelial function is assessed; and how NSAIDs and coxibs affect renal function and blood pressure is revisited. Several investigations provide insight into their mechanism and clinical application.
Dabu-Bondoc
Susan
S
Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut 06520-8051, USA. susan.dabu-bondoc@yale.edu
Franco
Samantha
S
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy; D018570:Risk Assessment
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors