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Celecoxib Effective In Rheumatoid Arthritis, With Fewer Ulcers Than Naproxen CHICAGO, IL -- November 23, 1999 -- Two anti-inflammatory agents have been found to be effective at providing pain relief and anti-inflammatory relief from arthritis while minimizing gastrointestinal (GI) side effects, according to articles in the November 24 issue of The Journal of the American Medical Association (JAMA). Dr. Lee S. Simon, from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston and colleagues analyzed whether the drug celecoxib reduces the incidence of GI mucosal damage compared with conventional nonsteroidal anti-inflammatory drugs (NSAIDs) in a randomized controlled, clinical trial. Patients in the 12 week study at 79 clinical sites were randomly assigned to receive twice per day 100 milligrams (mg.), 200 mg., or 400 mg. of celecoxib or 500 mg. of naproxen (a NSAID) twice per day, or a placebo. All doses of celecoxib and naproxen improved the signs and symptoms of arthritis. The incidence, however, of gastroduodenal ulcers determined by using an endoscope was: -- 4 percent (4 of 99) of patients receiving placebo -- 6 percent (9 of 148) of patients receiving 100 mg. (twice a day) of celecoxib -- 4 percent (6 of 145) of patients receiving 200 mg. (twice a day) of celecoxib -- 6 percent (8 of 130) of patients receiving 400 mg. (twice a day) of celecoxib -- 26 percent (36 of 137) of patients receiving 500 mg. (twice a day) of naproxen "Celecoxib produced improvement in the signs and symptoms of rheumatoid arthritis comparable with the effects of naproxen but with a significantly reduced incidence of endoscopically identified gastroduodenal ulcers" the authors write. "Thus, one of the major impediments that can limit the effective use of conventional NSAIDs, upper GI tract toxic effects, may potentially be obviated by the use of celecoxib." Celecoxib is an anti-inflammatory agent that inhibits cyclooxygenase 2 (COX-2) enzymes while allowing normal activity of cyclooxygenase 1 (COX-1) enzymes. According to the authors, celecoxib was effective at all doses studied at providing pain relief and anti-inflammatory relief while reducing the GI side effects more than naproxen, an anti-inflammatory agent that inhibits both COX-1 and COX-2 enzymes. Citing other studies, the authors note that approximately 20 percent to 30 percent of patients develop persistent adverse effects from conventional NSAID therapy, with more than 10 percent discontinuing treatment. "It is well established that conventional NSAID therapy can lead to gastroduodenal ulceration and associated serious complications of perforation, hemorrhage and gastric outlet obstruction. There is evidence to suggest that NSAID-induced ulcers and their resulting complications are largely caused by NSAID-mediated inhibition of mucosal prostaglandin [prostaglandins are fatty acids that act in a similar way to hormones] production, primarily mediated by COX-1 activity. Prostaglandins have been shown to modulate gastroduodenal mucosal protection by several interrelated mechanisms." (JAMA. 1999;282:1921-1928) Related Link: The Journal of the American Medical Association (JAMA). E-mail this page to a friend or colleague! To print, use this version