Abstract
Cyclooxygenase-1 (COX-1) derived eicosanoids promote gastroprotective mucosal defenses and induce platelet aggregation. By sparing COX-1, COX-2 specific inhibitors provide effective anti-inflammatory and analgesic activity while substantially reducing the risk of peptic ulcer disease and GI bleeding compared to dual COX inhibitors (traditional NSAIDs). Clinical studies of the COX-2-selective inhibitors have demonstrated efficacy equivalent to nonselective NSAIDs with significantly lower rates of GI toxicity. The incidence of endoscopic ulcers in some studies with coxibs has approximated placebo. However, as the detection of endoscopic lesions is not always correlated with symptomatic ulcers and ulcer complications, outcome studies of GI safety were performed. The results of large outcome studies have evaluated rofecoxib and celecoxib in over 39,000 patients with osteoarthritis or rheumatoid arthritis. Results of these studies showed that patients taking a supratherapeutic dose of rofecoxib or celecoxib had significantly lower rates of GI-related adverse events than those taking a nonselective NSAID. The GI safety of coxibs for patients using low dose aspirin concomitantly with a coxib appears to be reduced, particularly with regard to ulcer complications. Such data provide support for the COX-2 hypothesis and demonstrate that coxibs provide effective treatment of pain and inflammation with a reduced risk of gastropathy.
Keywords: nsaids, peptic ulcer disease, cost-effectiveness evaluation, gastrointestinal bleeding
Current Pharmaceutical Design
Title: Gastroduodenal Safety of Cyclooxygenase-2 Inhibitors
Volume: 9 Issue: 27
Author(s): James M. Scheiman
Affiliation:
Keywords: nsaids, peptic ulcer disease, cost-effectiveness evaluation, gastrointestinal bleeding
Abstract: Cyclooxygenase-1 (COX-1) derived eicosanoids promote gastroprotective mucosal defenses and induce platelet aggregation. By sparing COX-1, COX-2 specific inhibitors provide effective anti-inflammatory and analgesic activity while substantially reducing the risk of peptic ulcer disease and GI bleeding compared to dual COX inhibitors (traditional NSAIDs). Clinical studies of the COX-2-selective inhibitors have demonstrated efficacy equivalent to nonselective NSAIDs with significantly lower rates of GI toxicity. The incidence of endoscopic ulcers in some studies with coxibs has approximated placebo. However, as the detection of endoscopic lesions is not always correlated with symptomatic ulcers and ulcer complications, outcome studies of GI safety were performed. The results of large outcome studies have evaluated rofecoxib and celecoxib in over 39,000 patients with osteoarthritis or rheumatoid arthritis. Results of these studies showed that patients taking a supratherapeutic dose of rofecoxib or celecoxib had significantly lower rates of GI-related adverse events than those taking a nonselective NSAID. The GI safety of coxibs for patients using low dose aspirin concomitantly with a coxib appears to be reduced, particularly with regard to ulcer complications. Such data provide support for the COX-2 hypothesis and demonstrate that coxibs provide effective treatment of pain and inflammation with a reduced risk of gastropathy.
Export Options
About this article
Cite this article as:
Scheiman M. James, Gastroduodenal Safety of Cyclooxygenase-2 Inhibitors, Current Pharmaceutical Design 2003; 9 (27) . https://dx.doi.org/10.2174/1381612033454018
DOI https://dx.doi.org/10.2174/1381612033454018 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Matrix Metalloproteinases as Potential Targets in the Venous Dilation Associated with Varicose Veins
Current Drug Targets Clinical Approaches Toward Tumor Angiogenesis: Past, Present and Future
Current Pharmaceutical Design Pharmaceutical Polymeric Nanoparticles Prepared by the Double Emulsion- Solvent Evaporation Technique
Recent Patents on Drug Delivery & Formulation The Centrosome: A Target for Cancer Therapy
Current Cancer Drug Targets Cytokines and Growth Factors in the Treatment of Osteoarthritis: What Could be the Best Disease Modifying Drugs
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents Perspectives on the Use of Gene Therapy for Chronic Joint Diseases
Current Gene Therapy Modulation of T Cell Proliferation Through the LIGHT-HVEM-BTLA Cosignaling Pathway
Recent Patents on DNA & Gene Sequences Clinical Assessment of Autonomic Function in Fibromyalgia by the Refined and Abbreviated Composite Autonomic Symptom Score (COMPASS 31): A Case-Controlled Study
Reviews on Recent Clinical Trials Editorial [Hot Topic: Gold Derivatives as Anti-Cancer Agents (Guest Editor: Laura Rodriguez Raurell)]
Anti-Cancer Agents in Medicinal Chemistry Delivery Systems for Antimicrobial Peptides and Proteins: Towards Optimization of Bioavailability and Targeting
Current Pharmaceutical Biotechnology Oncogenic Fusion Tyrosine Kinases as Molecular Targets for Anti-Cancer Therapy
Anti-Cancer Agents in Medicinal Chemistry Apoptosis-Inducing Activity of the S100A8/A9 Heterodimer
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry 7-Azaindole Analogues as Bioactive Agents and Recent Results
Mini-Reviews in Medicinal Chemistry Ganoderma lucidum (Ling-zhi): The Impact of Chemistry on Biological Activity in Cancer
Current Bioactive Compounds Development of Biodegradable Injectable In situ Forming Implants for Sustained Release of Lornoxicam
Current Drug Delivery Editorial: Pulmonary Involvement in Systemic Disorders
Current Drug Targets - Inflammation & Allergy Inflammatory Diseases - New Compounds and Treatments
Current Organic Chemistry Covid-19: An Update on Clinical Features, Diagnosis, and Treatment Strategies
Coronaviruses Cerebral Vascular Aging: Extending the Concept of Pulse Wave Encephalopathy Through Capillaries to the Cerebral Veins
Current Aging Science Management of Antineutrophil Cytoplasmic Antibody Associated Vasculitis
Current Immunology Reviews (Discontinued)