Are All Oral COX-2 Selective Inhibitors the Same? A Consideration of Celecoxib, Etoricoxib, and Diclofenac.

IF 2.3 Q2 RHEUMATOLOGY International Journal of Rheumatology Pub Date : 2018-12-09 eCollection Date: 2018-01-01 DOI:10.1155/2018/1302835
Chris Walker
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引用次数: 35

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of arthritic conditions. Drugs in this heterogeneous class alleviate pain and inflammation by inhibiting cyclooxygenase-2 (COX-2). Cyclooxygenase-1 (COX-1) inhibition has traditionally been associated with increased gastrointestinal (GI) harm, whereas increased COX-2 selectivity has more recently become associated with greater risk of cardiovascular (CV) harm. When the entirety of data is considered, NSAIDs can be seen to exhibit a range of COX isoform selectivity, with all oral NSAIDs appearing to be associated with an increase in CV events. This review focuses on a comparison of the efficacy and the GI and CV safety profiles of three commonly used NSAIDs-celecoxib, etoricoxib, and diclofenac-using direct comparisons where available. While all three treatments are shown to have comparable efficacy, there are differences in their safety profiles. Both celecoxib and etoricoxib are associated with less GI harm than diclofenac despite the similarity of its COX-2 selectivity to celecoxib. Each of the three medicines under consideration is associated with a similar overall risk of CV events (fatal and nonfatal heart attacks and strokes). However, there are consistent differences in effects on blood pressure (BP), reported both from trials using ambulatory techniques and from meta-analyses of randomized trials, reporting investigator determined effects, with etoricoxib being associated with a greater propensity to destabilize BP control than either diclofenac or celecoxib.

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所有口服COX-2选择性抑制剂都是一样的吗?塞来昔布、依托昔布和双氯芬酸的考虑。
非甾体类抗炎药(NSAIDs)已被广泛用于关节炎的治疗。这类异质药物通过抑制环氧合酶-2 (COX-2)来减轻疼痛和炎症。环氧化酶-1 (COX-1)抑制传统上与胃肠道(GI)损害增加有关,而COX-2选择性增加最近与心血管(CV)损害风险增加有关。考虑到所有的数据,非甾体抗炎药可以显示出一定范围的COX亚型选择性,所有口服非甾体抗炎药似乎都与心血管事件的增加有关。这篇综述的重点是比较三种常用的非甾体抗炎药——塞来昔布、依托昔布和双氯芬酸的疗效和GI和CV安全性。虽然这三种治疗方法都显示出相当的疗效,但它们的安全性存在差异。尽管塞来昔布和依托昔布的COX-2选择性与双氯芬酸相似,但塞来昔布和依托昔布对胃肠道的危害都小于双氯芬酸。正在考虑的三种药物中的每一种都与心血管事件(致命性和非致命性心脏病发作和中风)的总体风险相似。然而,在使用动态技术的试验和随机试验的荟萃分析中,对血压(BP)的影响存在一致的差异,报告了研究者确定的影响,与双氯芬酸或塞来昔布相比,依托昔布更倾向于破坏血压控制的稳定。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
9
审稿时长
24 weeks
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