Have Cox2 inhibitors lived up to expectations?

Non-steroidal anti-inflammatory drugs are widely used, but they do cause clinically significant gastro-intestinal side effects notably bleeding, perforation or pyloric obstruction. Cox2 inhibitors were developed with the promise that while they retain the anti-inflammatory effects of NSAIDs the GI side effects can be minimized. There is a good evidence that incidence of endoscopic ulcers is significantly reduced in patients using Cox2 inhibitors. There is reasonably strong evidence from outcome studies that clinical outcome in terms of ulcer complications is also reduced. However, other concerns remain and the uncertainty about the potential of Cox2 inhibitors to cause cardiovascular disease including myocardial infarct. A comparison between Cox2 inhibitor and a combination of PPI and NSAIDs in preventing ulcer bleeding in patients with past history of bleeding ulcer failed to show any superiority of Coxibs over PPI and NSAID combination. Cox2 inhibitors have reduced the GI risk of patients needing anti-inflammatory drugs, but there are still unmet needs.