Which of the following is a Cox-2 (Cyclooxygenase-2) selective Non-Steroidal Anti-Inflammatory Drug (NSAID)?

From the Guidelines

Celecoxib (Celebrex) is the correct answer as it is a Cox-2 selective Non-Steroidal Anti-Inflammatory Drug (NSAID). Unlike traditional NSAIDs which inhibit both Cox-1 and Cox-2 enzymes, celecoxib specifically targets the Cox-2 enzyme while largely sparing Cox-1 1. This selectivity is important because Cox-1 helps maintain the protective gastric mucosa, while Cox-2 is primarily involved in inflammation and pain. By selectively inhibiting Cox-2, medications like celecoxib can reduce inflammation and pain while potentially causing fewer gastrointestinal side effects compared to non-selective NSAIDs.

• Key characteristics of Cox-2 selective NSAIDs include:
  • Reduced gastrointestinal side effects
  • Specific targeting of the Cox-2 enzyme
  • Potential increased risk of cardiovascular events, as noted in studies such as those discussed by the American Heart Association 1
• Other options, such as diclofenac sodium (Valtaren), indomethacin (Indocin), and naproxen (Naprosyn), are not Cox-2 selective NSAIDs, but rather traditional NSAIDs that inhibit both Cox-1 and Cox-2 enzymes.
• It is essential to consider the potential risks and benefits of celecoxib, particularly in patients with cardiovascular risk factors, and to use the lowest effective dose for the shortest duration necessary 1.

From the FDA Drug Label

Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal

• Cox-2 selective NSAID is defined as a type of Non-Steroidal Anti-Inflammatory Drug that selectively inhibits the Cyclooxygenase-2 (COX-2) enzyme.
• The correct answer is a. Celecoxib (Celebrex), as it is a COX-2 inhibitor 2 2.

From the Research

Cox-2 Selective NSAIDs

The following medications are options for Cox-2 selective NSAIDs:

• Celecoxib (Celebrex) is a Cox-2 selective inhibitor, as stated in studies 3, 4, 5, 6

Non-Selective NSAIDs

The following medications are not Cox-2 selective NSAIDs:

• Diclofenac sodium (Valtaren) is a non-selective NSAID, but it has some COX-2 selectivity, as mentioned in study 7
• Indomethacin (Indocin) is a non-selective NSAID
• Naproxen (Naprosyn) is a non-selective NSAID, as mentioned in studies 4, 5, 7

Key Points

• Celecoxib is approved for the relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other conditions, as stated in study 3
• Celecoxib has been shown to have significant equivalent anti-inflammatory and analgesic efficacy, with less gastrointestinal ulceration or erosion than non-selective NSAIDs, as mentioned in study 4
• The use of low doses of celecoxib in short-treatment, especially in patients with previous experience of GI events, may contribute to the decision-making process of prescribing COX-2 or NSAIDs, as suggested in study 6