Ask the Experts - COX-2 Inhibitors vs Traditional Nonselective...
Ask the Experts - COX-2 Inhibitors vs Traditional Nonselective...
Is there any information about physiologic function of cyclooxygenase-2 (COX-2) isotope enzyme in the human body? What do you think about superselective COX-2 inhibitors (ie, celecoxib and rofecoxib)? Is it better to use these superselective remedies instead of less selective (and cheaper) treatments?
Maros Varga, MD
There is a growing body of data concerning the physiologic functions of COX-2 in humans; however, many important questions remain to be completelyanswered.
The main advantages of the COX-2 selective agents is a lessened risk of gastropathy compared with that for traditional (nonselective) nonsteroidal anti-inflammatory drugs (NSAIDs). This has been demonstrated in short-term and longer-term endoscopy studies. Recently, in very long-term outcome studies (CLASS and VIGOR) it has clearly been shown that there is a significantly reduced risk of NSAID gastropathy and its attendant morbidity with the use of celecoxib and rofecoxib compared with traditional agents.
Thus, in patients with risk factors for NSAID gastropathy (eg, advancing age, previous history of gastrointestinal bleeding, concurrent use of anticoagulants, or prednisone or other NSAIDs), COX-2 selective agents would be preferable. Whether COX-2 inhibitors will be free of any renal toxicity remains to be seen, but results so far would seem to indicate that they are better tolerated than traditional NSAIDs in that regard.
One area of potential concern with superselective COX-2 inhibitors is a theoretical risk of clotting, because COX-2 agents block endothelial prostacyclin while having no effect on platelet thromboxane. Results from the larger studies would seem to indicate that patients at high risk of clotting events (eg, those with an established history of atherosclerotic disease) would benefit from the concurrent use of low-dose aspirin as prophylaxis.
Is there any information about physiologic function of cyclooxygenase-2 (COX-2) isotope enzyme in the human body? What do you think about superselective COX-2 inhibitors (ie, celecoxib and rofecoxib)? Is it better to use these superselective remedies instead of less selective (and cheaper) treatments?
Maros Varga, MD
There is a growing body of data concerning the physiologic functions of COX-2 in humans; however, many important questions remain to be completelyanswered.
The main advantages of the COX-2 selective agents is a lessened risk of gastropathy compared with that for traditional (nonselective) nonsteroidal anti-inflammatory drugs (NSAIDs). This has been demonstrated in short-term and longer-term endoscopy studies. Recently, in very long-term outcome studies (CLASS and VIGOR) it has clearly been shown that there is a significantly reduced risk of NSAID gastropathy and its attendant morbidity with the use of celecoxib and rofecoxib compared with traditional agents.
Thus, in patients with risk factors for NSAID gastropathy (eg, advancing age, previous history of gastrointestinal bleeding, concurrent use of anticoagulants, or prednisone or other NSAIDs), COX-2 selective agents would be preferable. Whether COX-2 inhibitors will be free of any renal toxicity remains to be seen, but results so far would seem to indicate that they are better tolerated than traditional NSAIDs in that regard.
One area of potential concern with superselective COX-2 inhibitors is a theoretical risk of clotting, because COX-2 agents block endothelial prostacyclin while having no effect on platelet thromboxane. Results from the larger studies would seem to indicate that patients at high risk of clotting events (eg, those with an established history of atherosclerotic disease) would benefit from the concurrent use of low-dose aspirin as prophylaxis.
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