How Important Is the Benefit from COX-2 Inhibitors?

Two multicenter studies offer perspective on the clinical significance of cyclooxygenase-2 (COX-2) inhibitors as an alternative to traditional nonsteroidal anti-inflammatory drugs.

In the first, 1149 patients with rheumatoid arthritis (RA) were randomized to celecoxib (100, 200, or 400 mg twice daily), naproxen (500 mg twice daily), or placebo. Any dose of celecoxib was as effective as naproxen in relieving RA symptoms. Gastrointestinal adverse effects (i.e., dyspepsia, diarrhea, abdominal pain, nausea, or flatulence) occurred in 26 percent of patients taking celecoxib and 31 percent of those taking naproxen. Endoscopically identified ulcers occurred in 4 percent of the placebo group, 5 percent of the celecoxib groups, and 26 percent of the …