Clinical implications of cyclooxygenase-2 inhibitors

Abstract

The mechanism underlying the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) is suppression of the activity of cyclooxygenase (COX). It has been surmised that selective COX-2 inhibitors can inhibit only the production of prostaglandin (PG) related to inflammation but not PG related to physiological functions. However, COX-2 is present in some tissues with physiological function. It has been established that selective COX-2 inhibitors are safer with respect to upper gastrointestinal tract complications than traditional nonselective NSAIDs. Furthermore, selective COX-2 inhibitors are effective in suppressing familial adenomatous polyposis. In contrast, recent studies have shown that selective COX-2 inhibitors and non-selective NSAIDs increase the cardiovascular risk. In Japan, celecoxib, a selective COX-2 inhibitor, was approved for clinical use in 2007. In this review, we outline the benefits and advantages of selective COX-2 inhibitors and suggest how best to use NSAIDs in daily clinical practice.