Super anti-inflammatory drugs
I’m very worried about all the controversy over super anti-inflammatory drugs (Vioxx, Celebrex and Bextra). Vioxx has been a miracle drug for me. Why is it so controversial? Should persons with cystic fibrosis be concerned about the undesirable effects of this drug?
The anti-inflammatories in question (Vioxx, Celebrex and Bextra) are in the COX-2 inhibitor class of drugs, as opposed to conventional anti-inflammatory drugs, which are both COX-1 and COX-2 inhibitors. COX-2 inhibitors are not really super anti-inflammatory drugs because their anti-inflammatory effect is no better than that of conventional anti-inflammatories (Advil, Naprosyn, Voltaren, Indocid, etc.). The advantage of COX-2 inhibitors is that they are less toxic for the gastrointestinal tract than conventional anti-inflammatory drugs: they cause less acidity, fewer ulcers and less stomach and duodenal bleeding.
Vioxx was withdrawn from the market because studies conducted after it was introduced showed an increased incidence of cardiovascular problems. This can be explained by the fact that the selectivity of COX-2 inhibitors causes the loss of a beneficial anticoagulant effect for blood vessels and platelets. Bextra was also quickly taken off the market, not only because of the cardiovascular risks, but also because it causes skin problems. Celebrex is still on the market, but it is being closely monitored because it may cause undesirable effects similar to those of Vioxx. It is clear, however, that the incidence of undesirable cardiovascular effects is much higher in people who already have cardiovascular risk factors (old age, smoking, elevated cholesterol and high blood pressure), which is not the case for the majority of the cystic fibrosis population. Patients with cystic fibrosis who need an anti-inflammatory drug and who do not have a cardiovascular risk factor could take Celebrex. They could also take conventional anti-inflammatory drugs along with a drug that provides protection against undesirable effects on the stomach.