Low-dose aspirin was synergistic with antithrombotic agents and corticosteroids, while coxibs
were synergistic with low-dose aspirin and SSRIs.
It is therefore imperative that further research be done to determine if conventional coxibs
are reliable enough to replace traditional NSAIDs as first-line agents.
Other drugs in the coxib
class include cerecoxib, sold by Pfizer under the brand name Celebrex, and etoricoxib, sold by Merck under the brand name Arcoxia.
This study compared nsNSAIDs as the reference treatment with coxibs
and opioids in 12,840 Medicare patients with osteoarthritis or rheumatoid arthritis (4,280 for each drug category).
Am J Gastroenterol 2008;103:221-227) Low GI risk High GI risk * Low CV Non-selective Non-selective risk NSAID NSAID + PPI or coxib
as monotherapy High Aspirin + Avoid all CV naproxen + PPI NSAIDs risk# GI=gastrointestinal, CV=cardiovascular, NSAID=non-steroidal anti-inflammatory drug, coxib
=selective cyclo-oxygenase-2 inhibitor, PPI=proton pump inhibitor.
Data Source: A propensity score-matched cohort analysis involving 12,840 elderly patients taking opioids, NSAIDs, or coxibs
for rheumatoid arthritis or osteoarthritis pain.
Update of ACR guidelines for osteoarthritis: Role of coxibs
This information prompted the European Medicines Agency and the US Food and Drug Administration to send out alerts indicating that the prescription of coxibs
was contraindicated for patients with symptomatic heart failure or a history of cardiovascular disease.
Pham K and Hirschberg R (2005): Global safety of coxibs
Given uncertainty over the continuing safety and utility of coxibs
, and the lack of clear interim guidance from national and international regulatory agencies, societies and organisations, physicians and their patients face a dilemma.
This helped illuminate the role that all NSAIDs--even coxibs
like celecoxib (Celebrex[R]) and valdecoxib (Bextra[R])--may play in hypervolemic hyponatremia among endurance athletes.
More than 200 GPs from the West Midlands took part in the research into coxibs
, a new treatment which appears to be free from the life-threatening side effects of traditional remedies.