Are {blacktriangledown}rofecoxib and {blacktriangledown}celecoxib safer NSAIDS?

Drug and Therapeutics Bulletin 2000;38:81-86

Are ${blacktriangledown}$ rofecoxib and ${blacktriangledown}$ celecoxib safer NSAIDS?

Relevant BNF section: 10.1.1

NSAIDs work by inhibiting the enzyme cyclo-oxygenase (COX),responsible for prostaglandin synthesis. This enzyme existsin two isoforms, COX-1 and COX-2. Inhibition of COX-1 is thoughtto be the main cause of the gastrointestinal unwanted effectsof NSAIDs, whilst inhibition of COX-2 results in anti-inflammatoryeffects.¹ ${blacktriangledown}$ Rofecoxib (Vioxx - MSD) and ${blacktriangledown}$ celecoxib (Celebrex -Searle) have been developed as selective inhibitors of COX-2.Rofecoxib is licensed for the symptomatic treatment of osteoarthritis,but not for rheumatoid arthritis. The manufacturer claims that"in clinical studies rofecoxib inhibits COX-2 but not COX-1",has "the power of high-dose NSAIDs - diclofenac and ibuprofen"and "superior GI safety profile compared to conventional NSAIDs".Celecoxib is licensed for symptom relief in osteoarthritis andrheumatoid arthritis. The manufacturer claims that celecoxibhas "comparable efficacy and superior GI tolerability when comparedto diclofenac or naproxen". Here, we review rofecoxib and celecoxiband consider whether they are safer than conventional NSAIDs.