A meta-analysis of 114 trials comparing COX-2 selective inhibitors
(rofecoxib, celecoxib, valdecoxib, parecoxib, etoricoxib, and lumiracoxib), conducted before June 2006, revealed significant heterogeneity in renal events (renal dysfunction, hypertension, and peripheral edema) between medicines in the class (p = 0.02), which was driven by rofecoxib .
The Vioxx Gastrointestinal Outcomes Research (VIGOR) trial, published in 2000, was the first to raise concerns that NSAIDs (specifically, the COX-2 selective inhibitor
rofecoxib) might be associated with a higher risk for cardiovascular (CV) events.
To observe whether or not the higher expression of COX-2 contributed to H/R-induced cell injury in H9C2 cardiomyocytes, the cells were incubated with the COX-2 selective inhibitor
, NS398, before being subjected to H/R.
Newer COX-2 selective inhibitors
had lesser side effects.
Conventional or non-selective NSAIDs do inhibit both cox-1 and cox-2, while cox-2 selective inhibitors
inhibit only cox-2.
Last year's study of 336,906 community-dwelling Medicaid beneficiaries by the Veterans Affairs Tennessee Valley Healthcare System extended concerns about COX-2 selective inhibitors
to cerebrovascular disease, said Dr.
Justification for the Development of COX-2 Selective Inhibitors
Strategies used to decrease the risk of NSAID-associated upper gastrointestinal clinical events include medical co-therapy with misoprostol or proton pump inhibitors (PPIs), or the use of COX-2 selective inhibitors
. The incidences of upper gastrointestinal clinical events have been shown to be significantly less with COX-2 selective inhibitors
than traditional NSAIDs in randomised gastrointestinal outcomes trials of 12 weeks - 12 months' duration.
The data suggest that "people who use low-dose aspirin for heart protection should take COX-2 selective inhibitors
rather than nonselective NSAIDs for treatment of arthritis and musculoskeletal pain," Dr.