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COX-2 selective inhibitors in the treatment of osteoarthritis

Loren Laine1, William B White, Alaa Rostom

  • 1Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. llaine@usc.edu

Seminars in Arthritis and Rheumatism
|January 8, 2008
PubMed
Abstract

Insights

Cyclooxygenase-2 selective inhibitors (coxibs) effectively treat osteoarthritis pain and function, similar to traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Coxibs offer reduced gastrointestinal risks but may increase cardiovascular events compared to some NSAIDs.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Gastroenterology

Background:

  • Osteoarthritis (OA) is a prevalent degenerative joint disease.
  • Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are common OA treatments.
  • Cyclooxygenase-2 selective inhibitors (coxibs) offer an alternative therapeutic option.

Purpose of the Study:

  • To evaluate the efficacy of coxibs in managing osteoarthritis.
  • To compare the safety profiles of coxibs versus traditional NSAIDs and acetaminophen.
  • To assess gastrointestinal, cardiovascular, renovascular, and hepatic side effects.

Main Methods:

  • Bibliographic database searches were conducted.
  • Included randomized controlled trials, meta-analyses, and literature reviews.

Main Results:

  • Coxibs demonstrated comparable efficacy to traditional NSAIDs for OA pain and function, outperforming acetaminophen.
  • Coxibs significantly reduced gastroduodenal ulcers and complications compared to traditional NSAIDs.
  • An increased risk of myocardial infarction was observed with coxibs versus placebo and naproxen, but not versus nonnaproxen NSAIDs.
  • NSAIDs, including coxibs, can cause fluid retention, increased blood pressure, and rarely, heart failure or renal dysfunction.
  • Hepatotoxicity is a rare side effect of NSAIDs, with elevated aminotransferases noted for rofecoxib and lumiracoxib.

Conclusions:

  • Coxibs are effective for osteoarthritis treatment, comparable to NSAIDs and superior to acetaminophen.
  • Coxibs provide a gastrointestinal safety advantage over traditional NSAIDs.
  • Cardiovascular risk associated with coxibs warrants consideration, particularly in comparison to specific NSAIDs.
  • Blood pressure elevation is a common side effect of both selective and non-selective NSAIDs, especially in hypertensive individuals.

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