To address unanswered questions regarding CV risk of coxibs
vs tNSAIDs, the FDA mandated a comparison of celecoxib with 2 tNSAIDs, ibuprofen and naproxen.
NSAIDs: potential clinical and phamacologic importance in veterinary medicine.
Finally, the integrated body of data demonstrating that aspirin use concomitantly with a coxib
creates ulceration at a rate similar to that of a dual inhibitor, clinical decision making should mandate additional strategies to reduce the risk in the relevant patients.
There is also an increased risk of thrombotic events, strokes and coronary events, with all NSAIDs, both coxibs
and non-selective NSAID agents, with the possible exception of naproxen.
Opioid users had significantly higher all-cause mortality (75 deaths per 1,000 person-years) than did either NSAID users (48 deaths per 1,000 person-years) or coxib
users (47 deaths per 1,000 person-years).
In laboratory studies, University of Michigan researchers found that several coxibs
, the drug class to which Celebrex belongs, interfere with aspirin's ability to discourage blood clots, if the aspirin is taken in low doses.
Bandolier Extra 2004 Evidence-based Healthcare NSAIDs, coxibs
, smoking and bone Available from: www.
rofecoxib has been withdrawn from the market because of its cardiovascular risk (4).
Six thousand patients with osteoarthritis of the knee were randomized to receive either the new coxib
(NCB) or the traditional coxib
NSAIDs: Potential Clinical and Pharmacologic Importance in Veterinary Medicine.
Though this coxib
-specific "prothrombotic mechanism" is still being investigated, the theory goes that by inhibiting the COX-2 enzymes that dilate blood vessels, while allowing the production of the COX-1 enzymes that cause blood platelets to stick, coxibs
can create a friendly environment for the formation of dangerous blood clots in some people.
In fact, while other agents have been shown to raise blood pressure between 4 and 6% in hypertensives, one coxib
in particular appears to raise it by some 25 to 30%.
Celecoxib (Celebrex[R]) and role coxib
(Vioxx[R]) are COX-2 inhibitors which have been marketed widely, directly to the public through the media when the safety of rofecoxib was questioned.
Had we made more significant changes earlier on, we probably would have lost Coxib
market leadership to Vioxx.
27: Leading coxib
brands in the global autoimmune market, 2006-07 94