Health Questions and Answers

Question: How do COX-2 anti-inflammatory drugs differ from older NSAIDs?


By preferentially inhibiting COX-2, newer NSAIDs are able to reduce inflammation with less impact on the remaining prostaglandins and therefore fewer side effects. Two points should be emphasized. The side effects of NSAIDs remain by and large toxicities for the entire class of compounds. COX-2 NSAIDs may preferentially inhibit COX-2, but there is much individual variation. So although it is much less likely for a patient to develop an ulcer with a COX-2 inhibiting NSAID, it remains possible. Finally, although there is a clear and measurable improvement in safety, there is no real improvement in efficacy; COX-2 NSAIDs are less likely to cause trouble, but no more likely to control pain than older NSAIDs.

Reference: Sheon RP, et al (eds): Soft Tissue Rheumatic Pain: Recognition, Management and Prevention, 3rd ed. Philadelphia, Lippincott Williams & Wilkins, 1996.

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