Cyclooxygenase-2 inhibition and cardiovascular events.

The Promise Introduction of selective cyclooxygenase (COX)-2 inhibitors held a promise of improved treatment of arthritis without the gastrointestinal effects associated with aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), which effect both COX-1 and COX-2 activity. Celecoxib, etodolac, meloxicam, and rofecoxib are classified as selective COX-2 inhibitors. Initial placebo and large scale comparative trials with NSAIDs have shown the effectiveness of selective COX-2 inhibition with a lower incidence of gastrointestinal side effects in patients with arthritis.1,2 These data, along with extensive marketing programs such as direct-to-consumer advertising, led to wide scale use.