Celecoxib

• this is a non-steroidal anti-inflammatory agent which is a specific inhibitor of enzyme cyclo-oxygenase 2. Celecoxib is licensed for the symptom relief in rheumatoid arthritis and osteoarthritis (1)
  
  
• the sparing of the COX-1 isoenzyme should, in theory, result in reduced gastrointestinal side-effects and improves tolerability. However the evidence that COX-2 selectivity reduces the risk of serious upper gastrointestinal side effects, particularly gastrointestinal bleeding and ulcer perforation, points towards some reduction of risk but the advantage over conventional non-steroidal anti-inflammatory drugs appears small (1)
  
  
• there is evidence that celecoxib has an anti-inflammatory effect as potent as diclofenac in the treatment of rheumatoid arthritis (2)

Advice for Prescribers in light of concerns about cardiovascular safety of COX-2 inhibitors (3)

• patients treated with any COX-2 inhibitor who have established ischaemic heart disease or cerebrovascular disease should be switched to alternative (non-COX-2 selective) treatments as soon as is convenient.
• for all patients, alternative treatments should be considered in light of an individual assessment of risks and benefits of COX-2 inhibitors, in particular cardiovascular, gastrointestinal and other risk factors.
• prescribers are reminded that for all NSAIDs (including COX-2 inhibitors), the lowest effective dose should be used, for the shortest duration necessary.
• for patients switched to chronic non-selective NSAIDs, consideration should be given to the possible need for gastro-protective treatments.

Reference

1. Drug and Therapeutics Bulletin (2000); 38 (11):81-86.
2. Emery P, Zeidler H, Kveim TK et al (1999). Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: randomised double-blind comparison. Lancet; 354:2106-11.
3. Medicines and Healthcare products Regulatory Agency (December 2004). Advice on the use of celecoxib and other selective cox-2 inhibitors in light of concerns about cardiovascular safety.