COX-2 Inhibitors: What Is Their Role?

Two selective inhibitors of cyclooxygenase-2 (COX-2) -- celecoxib (Celebrex) and rofecoxib (Vioxx) -- were FDA approved and marketed relentlessly in 1999. Their main attraction is a potential for fewer gastrointestinal side effects than traditional nonsteroidal anti-inflammatory drugs, which inhibit both gastroprotective COX-1 and proinflammatory COX-2.

One randomized trial compared the effects of rofecoxib and ibuprofen on the gastroduodenal mucosa of osteoarthritis patients (JW Nov 1, p. 165, accession number 991015001, and Gastroenterology Oct; 117:776). On endoscopic examination, rofecoxib was associated with about the same ulcer rate as placebo: 20 percent to 30 percent of that seen with ibuprofen. Clinically apparent complications were…