Swings and Roundabouts

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Science  07 Sep 2001:
Vol. 293, Issue 5536, pp. 1733
DOI: 10.1126/science.293.5536.1733a

Although introduced only 2 years ago, cyclooxygenase-2 (COX-2) inhibitors are already commonly prescribed in place of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). These new drugs offer similar therapeutic benefits but have greatly reduced gastrointestinal side effects.

A new study by Mukherjee et al., however, suggests that the benefits of COX-2 inhibitors may come hand in hand with some unexpected risks. Analyzing the published results of randomized clinical trials that compared COX-2 inhibitors with NSAIDs for treatment of arthritis and musculoskeletal pain, the authors found that thrombotic cardiovascular problems were more likely to occur in individuals taking the COX-2 inhibitors. Whether this is because the COX-2 inhibitors do not provide the antithrombotic effects of NSAIDs and aspirin or because they are prothrombotic is unclear. In animal studies, COX-2 has been shown to limit the extent of damage in ischemic heart tissue. Consistent with this, Dowd et al. show that COX-2 inhibition in rats exacerbates the heart damage caused by doxorubicin, a commonly used chemotherapeutic drug for cancer. — PAK

JAMA286, 954 (2001); J. Clin. Invest. 108, 585 (2001).

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