TARGET comprised 2 parallel substudies comparing the COX-2 selective inhibitor
lumiracoxib (not available in the United States) 400 mg daily with either ibuprofen 800 mg three times daily or naproxen 500 mg twice daily.
Our findings are in line with several previous studies which showed that treatment with COX-2 selective inhibitor
significantly improved cardiac function and reduced myocardial infarction size in different myocardial I/R animal models [12-15].
66) Preliminary evidence also suggests overall reduced GI complications with the COX-2 selective inhibitors compared with NS-NSAIDs, even with concomitant use of proton pump inhibitors.
Collectively, these studies demonstrate significantly reduced GI complications with COX-2 selective inhibitors, compared with NS-NSAIDs, and a reduction in potential fatalities resulting from GI complications.
In this trial the authors set out to compare the upper gastrointestinal safety of COX-2 selective inhibitors versus traditional NSAIDs in a way that simulated standard clinical practice.
The MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-term) programme provides a randomised comparison of the COX-2 selective inhibitor etoricoxib and the traditional NSAID diclofenac in 34 701 osteoarthritis and rheumatoid arthritis patients followed up for a mean duration of 18 months.
At low doses, some COX-2 selective inhibitors
may have no greater cardiovascular risk than other NSAIDs.
Although celecoxib is an effective NSAID, rofecoxib and lumericoxib are the only COX-2 selective inhibitors
that definitively reduce gastrointestinal (GI) ulcerations/complications compared with nonselective NSAID therapy.
Before withdrawal of Rofecoxib, the prescriptions of COX-2 selective inhibitors had accounted for 37% of the total NSAID prescriptions dispensed.
COX-2 selective inhibitors were negligibly prescribed (1%) in our study.
Numerous scientific and clinical trials have been conducted to assess the efficacy and safety of one or more COX-2 selective inhibitors
with other agents, particularly traditional NSAIDs.
For patients at high risk, COX-2 selective inhibitors
are reasonable second-line agents, since they pose a lower risk of NSAID-associated gastrointestinal complications with long-term use.