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Updated: May 1, 2026
High-throughput Fluorometric Measurement of Potential Soil Extracellular Enzyme Activities
Published on: November 15, 2013
[Not Available]
1Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany.
Abstract:
On the basis of relevant clinical studies performed so far, selective COX-2 inhibitors exhibit a therapeutic advantage over conventional NSAIDs with regard to the incidence of gastrointestinal (GI) damage such as perforation, ulceration, and bleeding (PUBs). The results prove that a risk reduction could be demonstrated during long-term treatment (6-9 months); nevertheless, PUBs cannot be ruled out under treatment with selective COX-2 inhibitors. In contrast to this, dyspeptic symptoms occur very frequently and their incidence is comparable to that of conventional NSAIDs. The increased incidence of thromboembolic, cardiovascular events documented in the VIGOR study for rofecoxib versus naproxen was not confirmed by comparison to placebo and other NSAIDs in additional clinical studies. In clinical studies no clear signs of thrombotic effects have been described for the therapeutic administration of celecoxib. Based on preclinical investigations as well as on the thromboembolic, cardiovascular events reported in connection with the therapeutic use of COX-2 inhibitors, safety measures are necessary and further investigations are recommended.
Insights
Selective COX-2 inhibitors reduce gastrointestinal damage compared to NSAIDs, but do not eliminate risk. Cardiovascular event concerns require further investigation and safety measures for these non-steroidal anti-inflammatory drugs.
Area of Science:
- Pharmacology
- Gastroenterology
Context:
- Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation.
- Gastrointestinal (GI) damage, including perforation, ulceration, and bleeding (PUBs), is a significant side effect of conventional NSAIDs.
- Selective COX-2 inhibitors were developed to reduce GI toxicity.
Purpose:
- To evaluate the efficacy and safety of selective COX-2 inhibitors compared to conventional NSAIDs.
- To assess the incidence of GI damage and cardiovascular events associated with selective COX-2 inhibitors.
Summary:
- Clinical studies indicate selective COX-2 inhibitors offer a therapeutic advantage over conventional NSAIDs, significantly reducing the incidence of GI damage (PUBs) during long-term treatment (6-9 months).
- However, PUBs are still possible with selective COX-2 inhibitors, and dyspeptic symptoms occur frequently, comparable to conventional NSAIDs.
- While initial concerns about increased cardiovascular events with some selective COX-2 inhibitors (e.g., rofecoxib) were noted, subsequent studies comparing them to placebo and other NSAIDs did not consistently confirm these findings. Celecoxib, in particular, has not shown clear thrombotic effects in clinical use.
- Preclinical data and reported cardiovascular events necessitate ongoing safety measures and further research into the thrombotic potential of COX-2 inhibitors.
Impact:
- Selective COX-2 inhibitors provide a safer alternative for patients at risk of GI complications from NSAIDs.
- The findings highlight the need for continued monitoring and research to fully understand the cardiovascular safety profile of selective COX-2 inhibitors.
- This information aids clinicians in making informed treatment decisions regarding pain management and inflammatory conditions.
