[Selective COX-2 inhibitors: do they retain any gastroduodenal toxicity].

Endoscopic studies have shown that cyclo-oxygenase-1 sparing non steroidal anti-inflammatory drugs (NSAIDs) of the coxib family did not produce more gastroduodenal ulcers than placebo in patients who were free of ulcer at baseline. However, the clinical relevance of these data is disputable. Only celecoxib and rofecoxib have been subject to large scale gastrointestinal outcome studies. Both have been shown to reduce the risk of symptomatic ulcers and ulcer complications (perforation, gastric outlet obstruction, bleeding) by about 50% compared to classical NSAIDs used at their maximum therapeutic doses. However, coxibs appear to retain some residual risk, especially in patients at high risk of developing serious gastrointestinal adverse events. This is the case in patients requiring low dose aspirin for cardiovascular purposes. Whether coxibs are still less toxic to the gastroduodenal tract that non-selective NSAIDs in these patients is controversial. Although coxibs have a superior upper gastrointestinal tolerability relative to traditional NSAIDs, dyspepsia, abdominal pain and nausea remain the major factor limiting their use.