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Cox-2 inhibitors: half measures

Although Cox-2 inhibitors present no demonstrable therapeutic advantages, they have been shown to cause serious adverse effects. Drug regulatory agencies have settled for half-measures that favour the interests of the pharmaceuticals industry.

New data confirm the cardiovascular risks associated with rofecoxib (Vioxx°, withdrawn from the market in 2004), as well as with other non-steroidal anti-inflammatory drugs (NSAIDs) known as Cox-2 inhibitors. Two separate trials compared rofecoxib against placebo for 3 years in more than 2,500 patients, and celecoxib against placebo in more than 2000 patients. These trials confirmed a higher incidence of thrombosis and heart failure in those taking Cox-2 inhibitors. In two trials among sufferers from Alzheimer’s disease, the mortality rate was double in those taking rofecoxib compared with those taking a placebo.

While there is increasing evidence of potentially fatal cardiovascular risks associated with Cox-2 inhibitors, the superiority of these anti-inflammatory drugs over traditional NSAIDs in terms of effectiveness and adverse gastrointestinal effects has still not been proven. European and French drugs regulatory bodies have opted to allow sales to continue, putting the interests of the pharmaceuticals industry before public health. Contraindications and warnings against prescribing them for patients presenting cardiovascular pathologies have only just been introduced for the Cox-2 inhibitors still on the market (in France, mainly celecoxib, alias Celebrex°).

There are other anti-inflammatory drugs for the same therapeutic indications, which are effective and present fewer potentially serious adverse effects.

See the many articles on Cox-2 inhibitors at www.prescrire.org.

©Prescrire April 2005

Source: "Coxibs, suite : demi-mesures et maintien sur le marché" Rev Prescrire 2005 ; 25 (260) : 281.

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