Selective cyclooxygenase-2 inhibitors: after the smoke has cleared

An enormous amount of fanfare and marketing preceded the introduction of selective inhibitors of cyclooxygenase-2 to the marketplace. These drugs were purported to offer equivalent anti-inflammatory and analgesic effects to conventional non-steroidal anti-inflammatory drugs without causing gastrointestinal injury. Now that there is considerable clinical experience with four drugs of this class having been available for at least two years, it is worthwhile re-visiting some of the original claims to determine whether selective cyclooxygenase-2 inhibitors have thus far lived up to their promise. In short, selective cyclooxygenase-2 inhibitors have proven to be somewhat safer in terms of gastrointestinal toxicity, than some (but not all) conventional non-steroidal antiinflammatory drugs. However their efficacy of the selective cyclooxygenase inhibitors has not always matched that of the conventional nonsteroidal anti-inflammatory drugs and there are significant safety concerns with some of the new drugs that deserve very careful consideration.