Without the White Coat
By Dr. Florentino Alerta II

CELECOXIB … removing the fear

Last year's report that a giant pharmaceutical company removed its COX2 (refocoxib) inhibitors from the market sent some of the biggest pharmaceutical firms coming out with public information on the safety of their products and have shown some studies to support it. The general public, in turn, due to fear stopped using the old anti-inflammatory agents in the markets (NSAIDS) which had shown to cause a lot of gastrointestinal effects than the rest of medications in the market.

The COX2 inhibitors had proven to be effective in treatment of osteoarthritis and the initial management of acute pain. The new safety information presented by CELEBREX in an accumulated of ten years and an involvement of 30,000 patients had never showed any cardiovascular risk as seen in the endpoint.

Last year pharmaceutical giant PFIZER and the US National Cancer Institute in an analysis of a two year study cancer prevention program trials had demonstrated an increase in cardiovascular risk with CELEBREX compared to placebo in the APC trial (Adenoma Prevention with CELEBREX), on the other hand the Prevention of Spontaneous Adenomatous Polyps or PreSAP trial revealed that there was no greater cardiovascular risk with CELEBREX compared with a placebo. PreSAP, an identical trial with APC with the analysis of its results which showed no cardiovascular events with those taking CELEBREX compared with the placebo group.

The US National Institute of Health (NIH) last December 20, 2004 in a long term study that had 2400 participants   sponsored by the National Institute on Aging(NIA) called as the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) a study designed to asses the potential benefit of the long term use of the NSAID naproxen sodium and CELEBREX in decreasing the risk of developing Alzheimer's disease in elderly age 70 years and older because of family history, but don't have the signs and symptoms of Alzheimers. Results show that there was an increase in cerebrovascular and cardiovascular events in patients taking naproxen compared to those taking placebo and there was no significant risk or increased in cardiovascular events in those patients taking CELEBREX compared to those taking placebo.

As physician we should weigh the greater effects and benefits of a celecoxib in the treatment   and management of osteoarthritis and acute pain management. With all the safety factors considered in management of osteoarthritis celecoxibs will still remain as a good treatment option. As experience dictates in management of acute pain the COX2 inhibitors had proven to be effective showing no other signs or side effects. We have always looked into the way of the dreaded outcome and side effects of gastrointestinal symptoms of NSAIDs like ulcers. Weighing the treatment outcomes the physicians will always prescribe the best medicine for his/her patient that could deliver the best effects on them and with minimal or no side effects at all.