An evidence-based evaluation of the gastrointestinal safety of coxibs

The American Journal of Cardiology
Claire Bombardier

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are nonselective inhibitors of cyclooxygenase (COX) isoforms COX-1 and COX-2. NSAIDs have analgesic and anti-inflammatory properties that are proven, and they are extensively used in the treatment of arthritis, pain, and headache. Despite their good efficacy, NSAIDs are associated with significant gastrointestinal (GI) toxicity, which appears to be related to the inhibition of the cytoprotective function of COX-1. Thus, selective COX-2 inhibitors, or coxibs, were designed to inhibit only the production of COX-2-dependent inflammatory prostaglandins, without any effect on COX-1 and its gastroprotective function. This article reviews important evidence on the GI safety of coxibs. Endoscopic studies demonstrated that coxibs, such as celecoxib and rofecoxib, induced significantly fewer ulcers than nonspecific NSAIDs. To analyze whether the incidence of clinical GI events is also lower with coxibs, 2 large controlled clinical trials, the Celecoxib Long-term Arthritis Safety Study (CLASS) and Vioxx Gastrointestinal Outcomes Research (VIGOR), evaluated the GI safety of celecoxib and rofecoxib, respectively. Based on evidence from the VIGOR trial, it was demonstrated that rofecoxib has alre...Continue Reading

References

Dec 1, 1994·The Journal of Clinical Investigation·R C HarrisM D Breyer
Dec 6, 1994·Proceedings of the National Academy of Sciences of the United States of America·K SeibertP Isakson
Jan 29, 1993·Biochemical and Biophysical Research Communications·L H WangK K Wu
May 23, 1998·Annual Review of Pharmacology and Toxicology·J R VaneR M Botting
Aug 26, 1998·British Journal of Rheumatology·M A IñiguezJ J Gomez-Reino
Jun 17, 1999·The New England Journal of Medicine·M M WolfeG Singh
Jun 23, 1999·Proceedings of the National Academy of Sciences of the United States of America·T D WarnerJ R Vane
Aug 7, 1999·The Journal of Biological Chemistry·L J MarnettC A Lanzo
Dec 2, 1999·JAMA : the Journal of the American Medical Association·L S SimonG S Geis
Nov 23, 2000·The New England Journal of Medicine·C BombardierUNKNOWN VIGOR Study Group
Jul 4, 2001·The Journal of Clinical Investigation·S Narumiya, G A FitzGerald
Jan 5, 2002·The New England Journal of Medicine·C M Nzerue
Jan 1, 1996·Mediators of Inflammation·Y S Bakhle, R M Botting

❮ Previous
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Citations

Nov 2, 2002·British Journal of Pharmacology·J N FrancischiY S Bakhle
Jul 6, 2007·BMC Gastroenterology·Michael LoydPhilip Jacobs
Apr 22, 2005·The American Journal of Medicine·Vincent T Martin, James A Goldstein
Nov 8, 2003·Current Pain and Headache Reports·Sait Ashina, Messoud Ashina
Aug 14, 2003·Experimental Gerontology·Klaus Turnheim
Oct 14, 2005·Journal of the American Veterinary Medical Association·B Duncan X LascellesDoug Reece
Feb 10, 2007·Current Oncology Reports·Maria Rosaria Raspollini, Gian Luigi Taddei
Apr 27, 2007·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·M LazzaroniG Bianchi Porro
Aug 8, 2007·Chemico-biological Interactions·Elif CadirciNurinnisa Ozturk
Nov 25, 2004·The American Journal of Geriatric Pharmacotherapy·Nicole R HartnellVolodko S Bakowsky
Jun 30, 2006·Prostaglandins, Leukotrienes, and Essential Fatty Acids·A J HallJ G Babish
Mar 15, 2005·Anesthesiology Clinics of North America·Noor M Gajraj, Girish P Joshi
Sep 1, 2004·Alimentary Pharmacology & Therapeutics·M Lazzaroni, G Bianchi Porro
May 19, 2005·Journal of Oral Rehabilitation·E Jedel
Jun 7, 2014·Expert Opinion on Drug Safety·Srinivas NalamachuRobert Taylor
Nov 1, 2005·The Journal of the American Dental Association·Michael SpinkRobert Glickman
Feb 21, 2004·Journal of the American College of Cardiology·William H Frishman
Jun 24, 2003·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·UNKNOWN Peripheral Arterial Diseases Antiplatelet Consensus Group
Aug 9, 2003·The Journal of Pharmacy and Pharmacology·Naveen AhujaBhupinder Singh
Jan 16, 2003·Seminars in Arthritis and Rheumatism·Nathaniel Katz
Sep 8, 2016·Pain Practice : the Official Journal of World Institute of Pain·Joseph V PergolizziJo Ann LeQuang
Dec 8, 2004·Experimental Gerontology·Klaus Turnheim
Jul 3, 2009·Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan·Hakan DursunOsman Kukula
Jun 21, 2006·Journal of Cardiovascular Pharmacology·Raymond C Harris
Dec 17, 2005·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Hermine I BrunnerDaniel J Lovell
Jan 16, 2016·Zeitschrift für Rheumatologie·W W BoltenUNKNOWN Kommission Pharmakotherapie der DGRh
Mar 6, 2012·Clinical Drug Investigation·Roberto LabiancaDiego Fornasari
May 15, 2004·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·David W J ClarkSaad A W Shakir
Mar 17, 2010·Journal of Perioperative Practice·Claire Frampton, Jane Quinlan
May 23, 2003·Anesthesia and Analgesia·Noor M Gajraj
Feb 15, 2013·Clinical Drug Investigation·Roberto LabiancaDiego Fornasari
Feb 27, 2003·Journal of Pain and Symptom Management·Gary Ruoff, Mark Lema

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