Emerging options with coxib therapy
Mark J. Lema, MD, PhD
Department of Anesthesiology, State University of New York at Buffalo School of Medicine, Buffalo, NY
The author has indicated that he has been a consultant for Merck and Purdue and is on the speakers’ bureaus of Merck and Purdue.
Future clinical applications of cyclooxygenase (COX)-2–selective inhibitors (coxibs) are likely to extend beyond their current use as oral analgesics in high-risk arthritis patients. The clinical utility of coxibs for the treatment of Alzheimer's disease (AD) is under investigation. Epidemiological surveys, preclinical studies, and preliminary clinical trials with nonsteroidal anti-inflammatory drugs (NSAIDs) have suggested that inflammatory mechanisms play a role in the neurodegeneration of AD. Clinical trials are currently being conducted to determine the effect of coxibs on the rate of AD progression. The use of coxibs as chemopreventive agents in colorectal cancer (CRC) is also under investigation. The chemopreventive benefits of coxibs to promote cell death (apoptosis) and inhibit angiogenesis in CRC have been shown in tumor cell lines and in animal and human models. In addition, palliative care clinicians and oncologists are increasingly including coxibs in their management of cancer pain. Coxibs are utilized for their opioid-sparing effect in the management of cancer pain, without impairing wound healing, or promoting bleeding diathesis (antiplatelet effects) or adverse gastrointestinal effects in patients receiving chemotherapy or radiation treatment.