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Titolo:
What have we learned from the large outcomes trials of COX-2 selective inhibitors? The rheumatologist's perspective
Autore:
Hochberg, MC;
Indirizzi:
Univ Maryland, Baltimore, MD 21201 USA Univ Maryland Baltimore MD USA 21201 iv Maryland, Baltimore, MD 21201 USA
Titolo Testata:
CLINICAL AND EXPERIMENTAL RHEUMATOLOGY
fascicolo: 6, volume: 19, anno: 2001, supplemento:, 25
pagine: S15 - S22
SICI:
0392-856X(200111/12)19:6<S15:WHWLFT>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; RANDOMIZED CONTROLLED TRIAL; RHEUMATOID-ARTHRITIS; CYCLOOXYGENASE-2 INHIBITOR; GASTROINTESTINAL TOXICITY; DOUBLE-BLIND; OSTEOARTHRITIS; ROFECOXIB; CELECOXIB; IBUPROFEN;
Keywords:
COX-2 selective inhibitor; nonsteroidal anti-inflammatory drug; osteoarthritis; rheumatoid arthritis; ulcer disease;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
54
Recensione:
Indirizzi per estratti:
Indirizzo: Hochberg, MC 10 S Pine St,MSTF 8-34, Baltimore, MD 21201 USA 10 S Pine St,MSTF 8-34 Baltimore MD USA 21201 , MD 21201 USA
Citazione:
M.C. Hochberg, "What have we learned from the large outcomes trials of COX-2 selective inhibitors? The rheumatologist's perspective", CLIN EXP RH, 19(6), 2001, pp. S15-S22

Abstract

The cyclooxygenase (COX)-2 selective inhibitors celecoxib and, rofecoxib have been found to be more, effective than placebo-and comparable effective to nonselective nonsteroidal antiinflammatory drugs: (NSAIDs) in the treatment of patients with osteoarthritis and rheumatoid arthritis. Two large outcome studies, the Celecoxib Longterm Arthritis Safety Study (CLASS) and Vioxx Gastrointestinal Outcomes Research (WIGOR) trial, were conducted to testthe hypothesis that patients receiving a COX-2 selective inhibitor would have significantly fewer clinically important upper gastrointestinal events than patients taking nonselective NSAIDs. This article critically reviews the design and results of these trials. Both trials found that arthritis patients not taking low-dose aspirin (325mg/ day or less) who were randomized to receive COX-2 selective inhibitorshad significantly fewer symptomatic and complicated ulcers than patients randomized to nonselective NSAIDs. A, significant risk reduction was not demonstrated, however; in patients in the CLASS trial who were taking low-doseaspirin, itself an independent risk factor for the endpoint. These data validate the COX-2 hypothesis and support recommendations that a COX-2 selective inhibitor should be used in the treatment of patients at increased riskfor symptomatic and complicated ulcers. Further studies are needed to determine whether COX-2 selective inhibitorsare safer than nonselective NSAIDs when used in patients receiving low-dose aspirin. The COX-2 selective inhibitors have a similar profile of renal adverse events to nonselective NSAIDs. The increased rate of cardiovascular thromboembolic adverse events among patients randomized to rofecoxib compared to those randomized to naproxen in the VIGOR trial is consistent with the lack of an antiplatelet effect for this COX-2 selective inhibitor This emphasizes the need for the use of low dose aspirin in patients at risk for such, events, especially myocardial infarction.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 02:12:38