COX-2 risk safety

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Analysis of data regarding the various non-steroidal anti-inflammatory drugs (NSAIDS)may eventually lead to the conclusion that COX-2-selective drugs carry a similar risk to non-COX-2 NSAIDs when it comes to cardiovascular events but that they have a lower gastrointestinal risk.

The evidence so far suggests that the cardiovascular risks are very similar for selective COX-2 inhibitors and non-selective NSAIDs.

COX-2-selective inhibitors are members of the NSAID class, and all produce their therapeutic effects through the common mechanism of inhibiting COX-2.

The difference between COX-2 drugs and traditional NSAIDs doesn't lie in what the newer drugs do, it lies in what they don't do. Let me explain...

The cardiovascular risks associated with selective COX-2 inhibitors are similar to those associated with the non-selective NSAIDS. In the US, the FDA concluded that the available data are best interpreted as being consistent with a class effect of an increased risk of serious adverse CV events for both and ruled that all these drugs should carry a boxed warning. European and Canadian regulators have also reached similar conclusions. A current clinical trial, the PRECISION study, should sort this out.

COX-2 drugs when combined with aspirin, unfortunately, have the same gastrointestinal risk as non-selective NSAIDS. In addition both non-selective NSAIDS and COX-2 NSAIDS adversely affect kidney function.

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