Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Cardiovascular Diseases; Cost-Benefit Analysis; Cyclooxygenase 2 Inhibitors; Drug Interactions; Gastrointestinal Diseases; Humans; Physician's Practice Patterns; Randomized Controlled Trials as Topic


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


PURPOSE: A summary of the basic science underlying the current controversies regarding cyclooxygenase-2 (COX-2)-selective nonsteroidal antiinflammatory drugs (NSAIDs), including data on their cardiovascular safety, their gastrointestinal (GI) benefits, cost-effectiveness, physician-prescribing trends, and recommendations for prescribing these agents is presented.

SUMMARY: A number of randomized controlled trials (RCTs) have reported that COX-2-selective NSAIDs increase cardiovascular events, although there appear to be gradations of risks among the COX-2-selective NSAIDs. In addition, traditional NSAIDs may increase the risk for cardiovascular events, complicating the interpretation of RCTs that use traditional NSAIDs as comparators. Selective inhibitors of COX-2-selective NSAIDs are effective antiinflammatory and analgesic drugs with improved upper-GI safety compared to traditional NSAIDs. Data on the cost-effectiveness of COX-2-selective NSAIDs indicate that they should be limited to patients at high risk for upper-GI adverse effects. However, they had been increasingly used in patients with lower GI risks until recent events reversed that trend. Circumstances under which COX-2-selective NSAIDs may be appropriate are in patients at high GI risk and in patients who did not respond to multiple traditional NSAIDs. The national spotlight in the United States on NSAID-related adverse events and recent lawsuits against health care providers prescribing COX-2-selective NSAIDs further highlights the need for provider-patient communication and risk disclosure. The relative cardiovascular risks of NSAIDs are similar in magnitude to other currently prescribed therapies.

CONCLUSION: Health care providers must consider the efficacy, GI and cardiovascular risks, concomitant medications, and costs when determining the appropriateness of COX-2-selective NSAID therapy.

DOI of Published Version



Am J Health Syst Pharm. 2006 Oct 1;63(19):1837-51. Link to article on publisher's site

Journal/Book/Conference Title

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

PubMed ID


Related Resources

Link to Article in PubMed