Osteoarthritis management: the role of cyclooxygenase-2-selective inhibitors

Cyclooxygenase (COX)-2-selective inhibitors are a new type of nonsteroidal anti-inflammatory drug (NSAID) for the management of pain caused by osteoarthritis (OA). The most recent OA guidelines from the American College of Rheumatology were published in 2000 because new therapies such as the COX-2-selective inhibitors had been introduced for the management of OA.

Because more data are now available on efficacy and safety issues with COX-2-selective inhibitors, NSAIDs, and acetaminophen, this review focuses on how COX-2-selective inhibitors may change the pharmacologic management of patients with OA.

References were obtained from MEDLINE, BIOSIS, EMBASE, and Internet searches of the literature.

The safety and efficacy of two COX-2-selective inhibitors, rofecoxib and celecoxib, have been examined in a number of clinical trials, and these agents have been shown to offer efficacy similar to that of NSAIDs. Acetaminophen continues to be the initial drug of choice for the management of OA because of its efficacy, safety, cost, and availability. COX-2-selective inhibitors should be considered in patients with OA who do not respond to or cannot tolerate therapy with acetaminophen. COX-2-selective inhibitors have an improved gastrointestinal (GI) safety profile compared with traditional NSAIDs and should be chosen over NSAIDs if prescription plan access and/or expense is not a concern. COX-2-selective inhibitors are clinically indicated for patients at increased risk of developing NSAID-induced GI complications, a population in whom the use of COX-2-selective inhibitors may be cost-effective because the incidence and mortality associated with serious GI adverse events and use of expensive GI comedications would be reduced.