Is there a rationale for the use of COX-2 inhibitors?
Reichenbach S., Nartey L., Tschannen B., Jüni P.
In the early 1990s two isoforms of Cyclooxygenase (COX) were found: COX-1 and COX-2. It was suggested that the anti-inflammatory properties of non-steroidal anti-inflammatory drugs (NSAIDs) were related to a COX-2 inhibition, whereas their adverse effects occurred because of a COX-1 inhibition. This led to a massive era of pharmaceutical development, which has resulted in the introduction of a group of new NSAIDs: the COX-2 inhibitors. Due to an aggressive marketing, two of them, rofecoxib and celecoxib, are increasingly used for a variety of painful conditions. However, the view that COX-2 inhibitors are safer than conventional NSAIDs is likely to be flowed. Currently there is no evidence suggesting that the modestly COX-2 selective drug celecoxib is safer than conventional NSAIDs for the gastrointestinal tract, while there is considerable evidence that the highly COX-2 selective drug rofecoxib has increased cardiovascular toxicity compared with traditional NSAIDs. Currently, there is no rationale for the use of COX-2 inhibitors. Rather, simple analgesics (paracetamol) and, if necessary, traditional NSAIDs (mainly didofenac or naproxen) should be used, potentially combined with a proton-pump inhibitor (e.g. omeprazole).