NEW YORK, Nov 23 (Reuters Health) -- Two new drugs are just as effective as existing medications at reducing the chronic pain and inflammation of arthritis, and they are less likely to cause ulcers and related woes, according to two reports published this week in The Journal of the American Medical Association.
Medications called nonsteroidal anti-inflammatory drugs (NSAIDs), which include the commonly used pain relievers ibuprofen and naproxen, often relieve the pain and inflammation of arthritis, but the relief comes with a catch. From 15% to 30% of long-term users of NSAIDs develop ulcers or other complications in the gastrointestinal tract, the researchers explain.
NSAIDs work by blocking an enzyme called cyclooxygenase-2 (COX-2), which is involved in pain and inflammation. But the drugs also inhibit a beneficial enzyme, COX-1, which is important for protecting the lining of the stomach and the gastrointestinal tract.
A new class of NSAIDs, called COX-2 inhibitors, spare the enzyme that protects the stomach and blocks only the enzyme involved in inflammation, according to the author of one of the studies, Dr. Lee S. Simon of Harvard Medical School in Boston, Massachusetts.
The hope has been that COX-2 inhibitors would relieve pain without causing ulcers and other side effects, Simon told Reuters Health in an interview. "They did exactly what we hypothesized," he said.
In Simon's trial, more than 1,100 people with rheumatoid arthritis were randomly assigned to take either naproxen (a conventional NSAID), one of several doses of celecoxib (a COX-2 inhibitor), or a placebo pill that did not contain any medication.
At the end of the 12-week study, naproxen and celecoxib proved to be about equal at relieving pain and inflammation, according to the investigators. However, patients taking celecoxib had significantly fewer gastrointestinal side effects than patients taking naproxen.
Specifically, depending on the dose, 4% to 6% of participants taking celecoxib developed ulcers during the study, Simon and his colleagues report. In contrast, 26% of the patients taking naproxen developed ulcers.
In a second report in the same issue, researchers found that another COX-2 inhibitor, rofecoxib, was less likely than conventional NSAIDs to cause complications such as ulcers, bleeding, and tears in the gastrointestinal tract.
Dr. Michael Langman, of the University of Birmingham in England, and colleagues analyzed the results of eight trials that compared rofecoxib with conventional NSAIDs for the treatment of arthritis. The studies included 3,357 people treated with rofecoxib, 1,564 treated with conventional NSAIDs, and 514 treated with placebo.
Over 12 months of treatment, participants who took rofecoxib had a 49% lower risk of developing gastrointestinal problems than those taking NSAIDs, the authors report.
Even though COX-2 inhibitors appear to cause fewer gastrointestinal side effects than other NSAIDs, they are not necessarily the best choice for all people with arthritis, according to a journal editorial by Dr. Walter Peterson, of the Veterans Affairs Medical Center in Dallas, Texas, and Dr. Byron Cryer, of the University of Texas Southwestern Medical Center at Dallas.
COX-2 inhibitors may be appropriate for patients who are at high risk for gastrointestinal complications, they say, but the high cost of the drugs make less expensive, conventional NSAIDs a better choice for people who have a low risk of developing such complications.
