HOT TOPIC: COX2 Inhibitors and NSAIDs

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HOT TOPICCOX-2 Inhibitors and NSAIDs

• By Christina Cairns

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Aim of Presentation

• History of COX-2 scare.
• What is the present evidence for COX-2s and
  NSAIDs?
• Benefits in using COX-2 or NSAIDs?
• Who are eligible using them?
• Take home message.

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History of COX-2 scare.

• APPROVe RCT showed ? risk of MI and CVA when
  using Rofecoxib.
• Another study later showed the same problems with
  Celecoxib and also with Valdecoxib.
• What about NSAIDs other than COX-2 Inhibitors?

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Present evidence for COX-2s and NSAIDs.

• Ibuprofen associated with a 24 ? MI risk c.f. to
  non-use
• Diclofenac and rofecoxib assoc. with 55 and 32
  ? in RR
• Not related to low dose aspirin use.

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Benefits in using COX-2s?

• No evidence of enhanced protection of COX-2s c.f.
  standard NSAIDs.
• DTB COX-2s same efficacy as NSAIDs with only
  slight improvement in dyspepsia.
• Any protective GI benefits from COX2s are lost if
  pt also on low-dose aspirin.
• In OA short term NSAIDs for flare-ups but then
  long term paracetamol.

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Who are eligible to use them?

• In the past combinations have been used in
  patients who need NSAIDs but are at higher risk
  of GI bleeds
• DTB January 2005 concluded avoid NSAIDs where
  possible!
• Trial of Paracetamol first
• Misoprostol is best to decrease risk of serious
  GI complications.

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Take home message.

• COX-2s should not be prescribed to people with
  vascular disease.
• Use NSAIDs only if absolutely necessary and
  short-term/low-dose only until further studies
  with better evidence are done.
• Use misoprostol if gastro-protection needed.
• Weigh up the risk-benefit for each patient.
• Counsel them if they have Hx of CVD