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Anti-inflammatory drugs to be avoided

In treating pain, when a nonsteroidal anti-inflammatory drug is deemed useful, it is better to use ibuprofen and avoid anti-inflammatory drugs such as cox-2 inhibitors.

The September issue of la revue Prescrire points out that to relieve osteoarticular pains, the first-line painkiller is paracetamol. As a second-line treatment, nonsteroidal anti-inflammatory drugs (NSAIDs) are used, in particular ibuprofen or naproxen.

When rofecoxib and etoricoxib, NSAIDs in the cox-2 inhibitor category, were commercialised in some European countries, la revue issued a reminder that cox-2 inhibitors are no more effective than other NSAIDs and do not offer any improvements in terms of serious adverse digestive effects. Furthermore, they often lead to an excess of cardiovascular and cutaneous risks compared with other NSAIDs. Thus rofecoxib (formerly Vioxx°) was withdrawn from the global market in 2004, due to a flagrant excess of adverse cardiovascular effects, with an increase in overall mortality. Valdecoxib was withdrawn in 2005. Other cox-2 inhibitors remained on the market in some European countries with a simple warning concerning the risks associated with them.

After analysing a hefty dossier (15,000 patients in one trial), la revue Prescrire concludes that etoricoxib is as disappointing as the other cox-2 inhibitors, with a mortality rate that tends to be higher than with the other NSAIDs. It is appalled at such financial and above all human waste, for such a mediocre result, which was largely predictable, while there are so many illnesses that are neglected.

©Prescrire Septembre 2007

Source: "étoricoxib-Arcoxia°. Aucune douleur ne justifie un coxib" Rev Prescrire 2007 ; 27 (287) : 645-650.

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