title: A review of the efficacy, safety, and cost-effectiveness of COX-2 inhibitors for Africa and the Middle East region.
abstract: Despite an increasingly sophisticated understanding of pain mechanisms, acute and chronic pain remain undertreated throughout the world. This situation reflects the large gap that exists between evidence and practice in pain management and is typified by inappropriate use of nonsteroidal anti-inflammatory drugs (NSAIDs). The scientific evidence around these drugs continues to expand at a high rate, yet physicians are often unaware of best practice. To address this gap among physicians in Africa and the Middle East, an Expert Panel meeting was convened with representatives from the region. The principal objective of the meeting was to review the latest guidelines on the management of acute and chronic pain and to review the efficacy, safety, and cost-effectiveness of cyclooxygenase-2 (COX-2) inhibitors in these settings. The main outcome of this review process was a number of consensus statements concerning the definitions of acute and chronic pain, and the efficacy, safety and cost-effectiveness of traditional nonselective NSAIDs (nsNSAIDs) and selective COX-2 inhibitors (coxibs). The panel agreed that nsNSAIDs and coxibs are effective analgesics with similar efficacy for acute pain; for chronic musculoskeletal pain, NSAIDs are significantly more effective than either placebo or paracetamol. Coxibs offer important safety advantages over nsNSAIDs, including gastrointestinal safety and preservation of platelet function; notably, the cardiovascular safety of coxibs has been the subject of much recent debate. Furthermore, the panel agreed there is substantial evidence to indicate that cost savings can be achieved by using celecoxib in patients at moderate to high risk of gastrointestinal adverse events, even in countries with moderate healthcare expenditures.
authors.affiliation: Faculty of Medicine, Alexandria University, Alexandria, Egypt. anwar_zeidan@yahoo.com
authors.forename: Anwar Z
authors.initials: AZ
authors.lastname: Zeidan
authors.forename: Bashar
authors.initials: B
authors.lastname: Al Sayed
authors.forename: Naceur
authors.initials: N
authors.lastname: Bargaoui
authors.forename: Mourad
authors.initials: M
authors.lastname: Djebbar
authors.forename: Malik
authors.initials: M
authors.lastname: Djennane
authors.forename: Royden
authors.initials: R
authors.lastname: Donald
authors.forename: Khamis
authors.initials: K
authors.lastname: El Deeb
authors.forename: Raed A
authors.initials: RA
authors.lastname: Joudeh
authors.forename: Abdullah
authors.initials: A
authors.lastname: Nabhan
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Schug
mesh_terms: D000349:Africa; D000068579:Celecoxib; D003362:Cost-Benefit Analysis; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008877:Middle East; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib