[Selective COX-2 inhibitors: do they retain any gastroduodenal toxicity]

Area of Science:

• Gastroenterology
• Pharmacology

Context:

• Cyclo-oxygenase-2 (COX-2) selective NSAIDs, or coxibs, were developed to reduce gastrointestinal toxicity.
• Previous studies indicated coxibs did not increase gastroduodenal ulcers compared to placebo in ulcer-free patients.

Purpose:

• To evaluate the clinical relevance and gastrointestinal safety of coxibs compared to traditional NSAIDs.
• To assess the risk-benefit profile of coxibs in specific patient populations, including those on low-dose aspirin.

Summary:

• Large-scale studies on celecoxib and rofecoxib show a ~50% reduction in symptomatic ulcers and complications versus traditional NSAIDs.
• Coxibs retain some gastrointestinal risk, particularly in high-risk patients (e.g., those on aspirin for cardiovascular disease).
• Despite superior upper GI tolerability, dyspepsia, abdominal pain, and nausea are common limiting side effects.

Impact:

• Coxibs offer improved upper gastrointestinal safety compared to non-selective NSAIDs.
• Understanding residual risks is crucial for optimizing coxib use in vulnerable patient groups.
• Further research is needed to clarify the comparative safety of coxibs versus non-selective NSAIDs in patients requiring concomitant aspirin therapy.