Celecoxib and rofecoxib: efficacy and safety of selective inhibitors of Cox-2 compared to non-selective NSAIDs

Abstract

Aims: To review most recent publications on efficacy and safety of COX-2 selective inhibitors, in order to assess a possible therapeutic advantage of this class of drugs as compared with NSAIDs. Methods: A systematic search of the Medline and IDIS (1999-2003) electronic databases was performed, searching for relevant papers that fulfilled the following criteria: (i) evaluation of compared efficacy of either celecoxib or rofecoxib with one or more NSAIDs; or (ii) evaluation of gastrointestinal, renal or cardiovascular adverse effects of these drugs; (iii) were studies performed in humans; (iv) were double blind (if experimental) and randomised studies; (v) were published in English. Conclusions: More recent publications show that COX-2 selective inhibitors have analgesic, anti-inflammatory and antipyretic efficacy and renal and cardiovascular safety equivalent to those of NSAIDs. Their only advantage is a superior gastrointestinal safety profile. However, due to their high cost, the substitution of COX-2 selective inhibitors for NSAIDs seems to be justified only in the patients with a high gastrointestinal risk. However, due to the scarcity of data concerning patients of gastrointestinal, renal and cardiovascular risk, treatment with these drugs should be introduced cautiously until more complete information is available. Efficacy and safety studies comparing celecoxib to rofecoxib should also be performed.