The cyclooxygenase (COX)-2 selective inhibitors @entity12698 and @entity13586 have been found to be more effective than placebo and comparably effective to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of @entity1 with @entity571 and @entity309 . Two large outcome studies, the Celecoxib Long-term @entity625 Safety Study (CLASS) and Vioxx Gastrointestinal Outcomes Research (VIGOR) trial, were conducted to test the hypothesis that @entity1 receiving a @entity2247 selective inhibitor would have significantly fewer clinically important upper gastrointestinal events than @entity1 taking nonselective NSAIDs. This article critically reviews the design and results of these trials. Both trials found that @entity625 @entity1 not taking low-dose @entity117 (325 mg/day or less) who were randomized to receive @entity2247 selective inhibitors had significantly fewer symptomatic and complicated @entity1066 than @entity1 randomized to nonselective NSAIDs. A significant risk reduction was not demonstrated, however, in @entity1 in the CLASS trial who were taking low-dose @entity117 , itself an independent risk factor for the endpoint. These data validate the @entity2247 hypothesis and support recommendations that a @entity2247 selective inhibitor should be used in the treatment of @entity1 at increased risk for symptomatic and complicated @entity1066 . Further studies are needed to determine whether @entity2247 selective inhibitors are safer than nonselective NSAIDs when used in @entity1 receiving low-dose @entity117 . The @entity2247 selective inhibitors have a similar profile of renal adverse events to nonselective NSAIDs. The increased rate of cardiovascular @entity1031 adverse events among @entity1 randomized to @entity13586 compared to those randomized to naproxen in the VIGOR trial is consistent with the lack of an anti-platelet effect for this @entity2247 selective inhibitor. This emphasizes the need for the use of low-dose @entity117 in @entity1 at risk for such events, especially @entity583 .

What have we learned from the large outcomes trials of XXXX selective inhibitors? The rheumatologist's perspective.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity13586 :: ('MESH:C116926', 'Chemical') :: ['rofecoxib'] @entity12698 :: ('MESH:C105934', 'Chemical') :: ['celecoxib'] @entity571 :: ('MESH:D010003', 'Disease') :: ['osteoarthritis'] @entity625 :: ('MESH:D001168', 'Disease') :: ['arthritis', 'Arthritis'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity1066 :: ('MESH:D014456', 'Disease') :: ['ulcers'] @entity1031 :: ('MESH:D013923', 'Disease') :: ['thromboembolic'] @entity2247 :: ('4513', 'Gene') :: ['COX-2'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis']
@entity2247 :: (4513,Gene) :: ['COX-2']
