Cyclooxygenase-2 inhibitors safety

Kaplan-Machlis B, Klostermeyer BS. The cyclooxygenase-2 inhibitors safety and effectiveness. Ann Pharmacother 1999 33(9) 979-88. 

Zembowicz A, Mastalerz L, Setkowicz M, Radzis-zewski W, Szczeklik A Safety of cyclooxygenase-2 inhibitors and increased leukotriene synthesis in chronic idiopathic urticaria with sensitivity to nonsteroidal anti-inflammatory drugs. Arch Dermatol 2003 139 1577-1582. 

Cyclooxygenase-2 (COX-2)-selective inhibitors produce results comparable with those of traditional NSAIDs. However, cardiovascular safety concerns and the high cost of COX-2 inhibitors argue against their use for this disorder. 

The efficacy and safety of cyclooxygenase-2 (COX-2) selective inhibitors (e.g., celecoxib) have not been fully assessed in gouty arthritis, but they are more costly than conventional NSAIDs and are unlikely to result in fewer GI complications because of the short duration of therapy. 

Filipponi et al. [7] studied the differences in the active sites of the two isoforms of cyclooxygenase (COX), an enzyme involved in the biosynthesis of pro-inflammatory prostaglandins. Two isoforms of COX exist a constitutive cyclooxygenase-1 and an inducible cyclooxygenase-2, and it is believed that COX-2 selective inhibitors provide anti-inflammatory agents with a superior safety profile [35]. 

The analgesic efficacy and safety profiles of the nonsalicylate NSAIDs make them appropriate alternatives to aspirin for treatment of mild to moderate pain. Most NSAIDs are used primarily for their anti-inflammatory effects, but they are also effective analgesics that relieve pain associated with a variety of ocular conditions. The nonsalicylate NSAIDs consist of the propionic acid derivatives, cyclooxygenase-2 (COX-2) inhibitors, and several other less commonly used agents (Table 7-2). 

Whelton A, Maurath CJ, Verburg KM, Geis GS. Renal safety and tolerability of celecoxib, a novel cyclooxygenase-2 inhibitor. Am J Ther 2000 7(3) 159-75. 

Simon LS, Lanza FL, Lipsky PE, Hubbard RC, Talwalker S, Schwartz BD, Isakson PC, Geis GS. Preliminary study of the safety and efficacy of SC-58635, a novel cyclooxygenase 2 inhibitor efficacy and safety in two placebo-controlled trials in osteoarthritis and rheumatoid arthritis, and studies of gastrointestinal and platelet effects. Arthritis Rheum 1998 41(9) 1591-602. 

Harris SI, Kuss M, Hubbard RC, Goldstein JL. Upper gastrointestinal safety evaluation of parecoxib sodium, a new parenteral cyclooxygenase-2-specific inhibitor, compared with ketorolac, naproxen, and placebo. Clin Ther 2001 23(9) 1422-8. 

Martin-Garcia C, Hinjosa M, Berges P, et al. Safety of cyclooxygenase-2 inhibitor in patients with aspirin-sensitive asthma. Chest 2002 121 1812-1817. 

El Miedany Y, Youssef S, Ahmed I, El Gaafaiy M Safety of etoricoxib, a specific cyclooxygenase-2 inhibitor, in asthmatic patients with a irin-exacerbated respiratory disease. Arm Allergy Ashma Immunol (2006) 97,105-9. 

Ott E, Nussmeier NA, Duke PC, et al. Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg 2003 125 1481-1492. 

Schug S, Joshi G, Camu F, Pan S, Cheung R. Cardiovascular safety of the cyclooxygenase-2 selective inhibitors parecoxib and valdecoxib in the postoperative setting an analysis of integrated data. Anesth Analg 2009 108 299-307. 

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