[Safety of selective cyclooxygenase-2 inhibitors taken for a long time]

The serious digestive side effects of the selective inhibitors the inducible cyclooxygenase-2 are reduced by 60% as compared to the nonselective non-steroidal anti-inflammatory drugs. The main risk factors associated with gastro-intestinal ulcers caused by the latter were found also with the selective inhibitors taken for long period (age > 60 years, antecedents of gastro-duodenal ulcers, concomitant aspirin treatment). In contrast, H. pylori infection was not found as risk factor apart from past history of gastro-duodenal ulcers. The complications in the lower digestive tract are twice less frequent with the selective inhibitors than with nonselective anti-inflammatory drugs. Nevertheless, it seems that the risk of exacerbation of inflammatory colitis is not reduced. The cardiovascular complications are discussed. Rofecoxib taken at supra-therapeutic dosage was recognised to increase the incidence of myocardial infarction. A such increase was not found with usual dosage or with celecoxib. The selective inhibitors may reduce the renal sodium excretion and increase the blood pressure, particularly in hypertensive patients whose the blood pressure has to be regularly checked.