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| |  DG DISPATCH - AAPM: Differentiating Coxibs From Nonsteroidal Anti-Inflammatory Drugs By Lisette Hilton Special to DG News
MIAMI, FL -- February 19, 2001 -- Nonsteroidal anti-inflammatory drugs (NSAIDs) are thought to cause about 100,000 hospitalizations and between 10,000 and 15,000 deaths a year in the United States. Two medications marketed in the last two years, Celebrex (celecoxib) and Vioxx (rofecoxib), are showing that they might offer many of the benefits of NSAIDs without some of the severe gastrointestinal (GI) side effects, according to David Peura, MD, gastroenterologist and professor of medicine at University of Virginia, Charlottesville, Virginia. Dr. Peura chaired "New Evidence of Differentiating COXIBs in Pain Medicine," held on Sunday (Feb. 18) during the American Academy of Pain Medicine 17th annual meeting in Miami Beach, Florida. COXIBs, the generic designation given to the newer agents that selectively inhibit the COX 2, have been shown to be associated with a lower incidence of symptomatic ulcers and ulcer complications when compared with NSAIDs, Dr. Peura said. These side effects tend to be more common in the elderly and others with histories of ulcers and other GI disorders, he said. Studies also show that health care costs are reduced with COXIB use because there is less need for hospitalization, prescribing co-medications and doing endoscopies, he said. COXIBs aren’t without problems, however. According to Dr. Peura, people who take COXIBs still experience the nuisance symptoms seen with NSAIDs, including dyspepsia, indigestion, abdominal pain and heartburn. The severity of these nuisance symptoms, however, seems to be less compared with NSAIDs. In addition, like NSAIDs, COXIBs have the potential to cause kidney problems. One disturbing finding of recent studies was that individuals taking COXIBs seem to have a larger number of heart attacks. "It wasn’t that the drugs were bad," he said. "It was that during the study, people had to be off of their aspirin." As for the future of COXIBs, researchers are studying an intravenous formulation for the hospital setting. Other areas of study include COXIB use for the prevention of colon polyps and colon cancer, as well as research to determine how COXIB affect Barrett’s esophagus and Alzheimer’s disease, according to Dr. Peura. "[Especially] in older people and people who have risk factors, I think there is no question that these drugs are effective and safe and should be considered for first-line use," Dr. Peura concluded.
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