Combination Drugs
A model comparing the theoretical relative frequency of gastrointestinal adverse effects and cost effectiveness of celecoxib, nonspecific NSAIDs alone, NSAIDs plus a proton pump inhibitor, NSAIDs plus an H2 receptor antagonist, NSAIDs plus misoprostol, and diclofenac/misoprostol, found the lowest probability of adverse gastrointestinal events for celecoxib, followed by NSAIDs plus a proton pump inhibitor, NSAIDs plus an H2 receptor antagonist, NSAID plus misoprostol, diclofenac/misoprostol, and NSAID alone. In total cost, including drug plus treatment of any gastrointestinal effects, the lowest cost treatment was celecoxib, followed by NSAIDs alone and diclofenac/misoprostol, with the other NSAID plus gastrointestinal protection regimens being much more costly. Similarly, a model of cost effectiveness of rofecoxib and celecoxib compared to high-dose acetaminophen or ibuprofen, with and without misoprostol, in patients with osteoarthritis of the knee found that acetaminophen had the lowest cost for average patients. For those not responding to paracetamol, ibuprofen was the most cost effective treatment by a large margin, but for those who did not respond to acetaminophen and had a high risk of gastrointestinal damage, rofecoxib was the most cost effective treatment.
The adverse effects of COX 2 inhibitors are the subject of extensive scientific debate. Several studies have pointed to a subtle increase in the risk of myocardial infarction, hypertension and also potential gastrointestinal complications. The following examples illustrate some of these risks, however (as with all medications) a consulation with a medical professional should be sought to discuss these issues before a firm opinionregarding their safety is established.
A French study of osteoarthritis patients over 65 years of age determined that, compared to Celebrex (200 mg once daily), patients taking Vioxx (25 mg once daily) suffered a two-fold increase in clinically significant edema and 60% more frequent increases in systolic blood pressure greater than 20 mmHg, as early as the second week of treatment. This has significant implications, since it has been estimated that every 2 mmHg increase in blood pressure raises the risk of stroke by two thirds and the risk of myocardial infarction by one third, suggesting that Celebrex may be a better choice for hypertensive patients or those at risk for edema. In addition, COX-2 inhibitors lack some of the platelet inhibiting properties of aspirin and other nonspecific NSAIDs and may, directly or indirectly, lead to increased risk of thrombosis, particularly in high risk patients where low dose aspirin therapy is warranted. On the other hand, this property makes them a better choice for perisurgical pain management, where inhibition of blood clotting would be problematic.
There are other differences between Celebrex and Vioxx that influence prescribing practices. Patients with known sensitivity to sulfa drugs are likely to be sensitive to Celebrex as well, due to similarity in structure. Vioxx has a more rapid onset and is approved for acute pain as well as osteoarthritis, while Celebrex is approved for rheumatoid arthritis as well as osteoarthritis.
Read more about this topic: COX-2 Inhibitor
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