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NSAIDS: COX-2 inhibitors should be withdrawn

Celecoxib should be taken off the market, given its negative benefit-harm balance.

The class of nonsteroidal anti-inflammatory drugs (NSAIDs) known as cox-2 inhibitors has been one of the most controversial health issues in the media in recent years.

Medical and consumer publications alike trumpeted these drugs as being easily as effective as the other NSAIDs, with fewer gastrointestinal adverse effects; but these claims were based on misleading clinical trial results.

Then a growing body of evidence revealed that cox-2 inhibitors were no more effective than other NSAIDs. In 2007 the French committee that assesses the medical benefits of new drugs and provides recommendations concerning drug reimbursement (Commission de la transparence) concluded that celecoxib offered no added therapeutic benefit. Meanwhile, adverse effects resulted in the withdrawal of rofecoxib, which was implicated in tens of thousands of cardiovascular events, some fatal. Merck's withdrawal of the drug in 2004 was presented as a disaster… for the firm's shareholders. But since then, share values have more than bounced back. And the company was able to offer nearly 5 billion dollars to settle legal proceedings in the USA.

Prescrire, which has always advised against the use of cox-2 inhibitors, is appalled that more than a million packages of celecoxib were reimbursed by the French public health insurance system in 2006, at a cost of over 23 million euros.

No amount of pain justifies exposing patients to the adverse effects and cardiovascular risks associated with celecoxib.

©Prescrire 1 January 2008

Source: "Celecoxib : toujours là… hélàs !" Rev Prescrire 2008; 28 (291): 13.

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