• Government
• Profession
• Business
• Opinion
• Health

• Health reform
• H1N1
• P4P
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Book Excerpt
• Business Pitch
• Meetings
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Writers
• Other years

• Search tips
• E-mail alert
• Radio
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

Good news and bad news about COX-2 inhibitors

The medicine decreases cancer risk while boosting cardiovascular disease risk. Researchers are hopeful about the future of chemoprevention of carcinoma.

By Victoria Stagg Elliott, amednews staff. Sept. 25, 2006.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE

In September 2004, preliminary trial data were released suggesting that long-term use of COX-2 inhibitors brought an increased cardiovascular risk.

The finding made a big splash and ultimately led to the dislodging of this drug class from the bestseller list.

Now, two years later, the research question these projects were designed to answer -- whether the COX-2s offer protection from certain cancers -- has been solved. These drugs do reduce the chance of colorectal polyps in patients who have a history of them, but the price of this prevention is a dramatically increased risk of heart and vascular disease, according to a pair of studies published in the New England Journal of Medicine last month. The trials randomized just over 3,500 patients to various dosages of celecoxib (Celebrex) or placebo.

A related paper, this one published in the August online edition of Gastroenterology and expected in print in December, involved patients receiving 25 mg of rofecoxib (Vioxx) and reached similar conclusions.

"The clear message is that COX-2 inhibitors prevent colon polyps, and the effect is fairly substantial," said Curt Furberg, MD, PhD, professor of public health sciences who participated in the Food and Drug Administration advisory committee meetings regarding safety issues related to these drugs. "But that's just one effect."

An editorial, also in the August New England Journal of Medicine, concluded that the dream of using currently available COX-2 inhibitor medications for cancer prevention in the general population is effectively dead. The burden of cardiovascular disease associated with their use is too great. Also, although this regimen was proven to reduce polyps that can lead to colorectal cancer, it has yet to be shown to prevent actual cancers.