PAIN-NSAID VS COX-2 INHIBITORS

SUMMARY

1. Major studies, including the Vioxx Gastrointestinal Outcomes Research (VIGOR) trial, the Celecoxib Long-term Arthritis Safety Study (CLASS), and the Safety and Efficacy Large-Scale Evaluation of COX Inhibition Therapies (SELECT) trial, demonstrated significant safety benefits of COX-2 inhibitors compared with non-selective NSAIDs with regard to reduced incidence of symptomatic gastric ulcers and renal toxicity.

2. The VIGOR trial, however, reported a 2.38-fold increase in relative risk of cardiovascular events among study patients with rheumatoid arthritis randomly assigned to rofecoxib treatment.

3. Selective COX-2 inhibitors can decrease vascular prostacyclin (PGI2) production, interfering with the balance between prothrombotic and anti-thrombotic eicosanoids (thromboxane A2) and increasing the likelihood of cardiac events.

4. FDA concluded that an increased risk of serious adverse cardiovascular events might be a class effect for NSAIDs (excluding aspirin).

5. Ongoing monitoring of BP, cardiac, and renal status is recommended with acute and chronic use of both nonselective NSAIDs and selective COX-2 inhibitors.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.