New cyclooxygenase inhibitors

The discovery of the two isoforms of cyclooxygenase (COX-1 and COX-2) has paved the way for the development of a new class of non-steroidal anti-inflammatory drugs (NSAIDs). The COX-2 inhibitors have shown comparable efficacy to the traditional NSAIDs with less gastrointestinal side effects in major clinical studies. The aims of this paper are to provide a brief historical background, pharmacology of cyclooxygenase inhibitors as well as discuss the latest update on COX-2 inhibitors.

A MEDLINE search was performed for relevant articles from leading medical journals from 1990 to 2000. The papers reviewed include randomised controlled clinical trials, meta-analyses and review articles.

The arrival of the COX-2 inhibitors into the treatment armamentarium for inflammation and analgesia has been widely accepted and welcomed. Although this new group of "wonder" drugs cause less gastrointestinal side effects, they are not renal sparing and do not have cardioprotective effects. Studies have also yet to establish its safety in NSAID-sensitive patients. In patients with chronic arthritides, cost is also an important factor to consider when prescribing these medications. Their strengths and weaknesses will become apparent with continued use.