Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation by blocking cyclo-oxygenases (COX), enzymes that are needed to produce prostaglandins. Most NSAIDs block two different cyclo-oxygenases, called COX-1 and COX-2. COX-2, found in joint and muscle tissue, contributes to pain and inflammation. Many NSAIDs also block COX-1, which may contribute to development of ulcers and gastrointestinal bleeding depending on the magnitude of blockade. More recently, some NSAIDs have also been associated with an increased risk of serious cardiovascular events, such as myocardial infarction. The purpose of this review is to compare the efficacy, effectiveness, and harms of NSAIDs.

Contents

• Introduction
  • Scope and Key Questions
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Validity Assessment
• Results
  • Overview
  • Key Question 1. Are there differences in effectiveness between coxibs and other NSAIDs?
  • Key Questions 2 and 3. Are there clinically important differences in short-term safety or adverse effects between celecoxib, other NSAIDS, or the combination of a nonselective NSAID plus antiulcer medication? Are there clinically important differences in long-term safety or adverse effects between celecoxib, other NSAIDS, or the combination of a nonselective NSAID plus antiulcer medication?
  • Key Question 4. Are there subgroups of patients based on demographics, other medications (e.g., aspirin), or co-morbidities for which one medication is more effective or associated with fewer adverse effects?
• Summary
• References
• Appendixes
  • Appendix A. NSAIDs selectivity
  • Appendix B. Search Strategy
  • Appendix C. Quality assessment methods for drug class reviews for the Drug Effectiveness Review Project
  • Appendix D. Excluded trials

Suggested citation:

Chou R, Helfand M, Peterson K, Dana T. (2004). Drug Class Review of Cyclo-oxygenase (COX)-2 Inhibitors and Non-steroidal Anti-inflammatory Drugs (NSAIDS). http://www.ohsu.edu/drugeffectiveness

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.