is now indicated for the treatment of pain associated with juvenile rheumatoid arthritis, making it the first COX-2 inhibitor approved for use in children.
M1 NSAIDs except naproxen were associated with higher risk for cardiovascular death, which increased by 58% with rofecoxib
, roughly doubled with ibuprofen, celecoxib, or lumiracoxib, and increased approximately fourfold with diclofenac or etoricoxib, compared with placebo.
Classification of NSAIDs according to COX-selective properties COX-1 selective Non-selective COX-2 selective Indomethacin Diclofenac Celecoxib Piroxicam Naproxen Etoricoxib Lornoxicam Ibuprofen Parecoxib * Tenoxicam Nabumetone Rofecoxib
([dagger]) Ketoprofen Sulindac Valdecoxib ([dagger]) Ketorolac Lumiracoxib ([dagger]) Mefenamic acid Meloxicam * Parenteral formulation only ([dagger]) Withdrawn from the market, including South Africa.
was associated with a 35% relative increase in cardiovascular events compared to placebo with a 2-fold increase in risk with doses in excess of 25 mg/day.
Two Cochrane reviews (6-7) confirmed the efficacy of celecoxib (Celebrex) and rofecoxib
in treating of rheumatoid arthritis.
The investigators found that there was no link between COX-2 use and nonfatal MI, but the use of rofecoxib
was associated with "significantly higher odds of MI," when compared with celecoxib (adjusted odds ratio 2.
The US national estimate of the fatal heart attack plus sudden cardiac death was 44 per cent, which suggests that many of the excess cases attributable to rofecoxib
use were fatal.
After studying volunteers with mild-to-moderate symptoms of Alzheimer's disease for a year, the researchers determined that neither daily rofecoxib
nor twice-daily naproxen (Aleve) produced significant benefits over an inert pill.
C, randomly assigned 351 participants to one of three treatment groups: rofecoxib
, naproxen, or placebo.
Major Finding: People taking an NSAID--ibuprofen, diclofenac, rofecoxib
, or celecoxib--had a significantly increased risk for fatal or nonfatal stroke on days taking the drug in a multivariate analysis.
That falls to one in 695 of those on rofecoxib
and one in 1005 on ibuprofen.