COX-2 agents, with their perceived reduction in side effects, have contributed substantially to a dramatic increase in NSAIDs (non-steroidal anti-inflammatory drugs) prescription utilization and influenced the way physicians prescribe rheumatology medication, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Antonio, Texas.
Traditional or non-selective NSAIDs, such as diclofenac, piroxicam, ibuprofen and naproxen, are effective inhibitors of the enzyme cyclooxygenase (COX) 1 and 2 and, therefore, able to reduce inflammation and musculoskeletal pain COX-1 enzymes help maintain the body's internal stability; COX 2 enzymes signal pain and inflammation.) However, the inhibition of COX-1 enzyme increases the risk for gastrointestinal complications such as bleeding or ulcers in some patients. In 1999, the first selective COX-2 inhibitor, celecoxib (Celebrex®), appeared on the market, followed by rofecoxib (Vioxx®), and valdecoxib (Bextra®). These COX-2 agents selectively inhibit cyclooxygenase 2, the enzyme responsible for inflammation and pain, thereby reducing the incidence of GI side effects.