From the Guidelines
Celecoxib is the correct answer as it is a nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2). The question asks for a COX-2 selective inhibitor, and based on the provided evidence, celecoxib is the one that fits this description.
- The evidence from 1 and 1 supports the fact that celecoxib is a COX-2 selective inhibitor, which reduces pain and inflammation while potentially causing fewer gastrointestinal side effects compared to non-selective NSAIDs.
- The study from 1 also mentions that celecoxib seems to be safer in terms of cardiovascular risks compared to other COX-2 inhibitors.
- It is worth noting that the other options, such as meloxicam, naproxen, and piroxicam, are not COX-2 selective inhibitors, and therefore, are not the correct answer.
- The use of celecoxib should be done with caution, considering the potential cardiovascular risks and taking into account the patient's individual risk factors, as recommended by the studies 1, 1, and 1.
From the Research
COX-2 Selective Inhibitors
- Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits the inducible isoform of the cyclo-oxygenase (COX)-2 enzyme 2, 3, 4.
- This selective inhibition of COX-2 by meloxicam reduces the incidence of gastrointestinal side-effects compared to other NSAIDs 2, 3, 5.
- Meloxicam's COX-2 selectivity is also evident in its effects on platelet aggregation and thromboxane formation, which are exclusively COX-1 dependent, and are not significantly affected by meloxicam 6.
Comparison with Other NSAIDs
- Naproxen, indomethacin, and piroxicam are not selective COX-2 inhibitors, and have been shown to have a higher incidence of gastrointestinal side-effects compared to meloxicam 2, 3, 5, 6.
- Meloxicam has been found to be at least as effective as other NSAIDs, such as naproxen and diclofenac, in the treatment of osteoarthritis and rheumatoid arthritis, but with a lower incidence of gastrointestinal side-effects 2, 3, 5.