Editorial [Hot Topic: COX-2 Inhibition in Gastroenterology and Rheumatolgy:Current Challenges and Perspectives for the Future (Executive Editor: Angel Lanas)]

For the last two years the field of COX inhibition has been involved in an intense and hot debate regarding the benefits and risks associated with the use of these drugs. For years, the benefits of these drugs were focused on the relief of pain and inflammation of different rheumatic conditions and the side effects on those located in the upper gastrointestinal tract. The introduction of the COX-2 selective inhibitors in the market brought new hope since the hypothesis was that these drugs were as effective as non-selective NSAIDs in treating rheumatic conditions, were associated with less gastrointestinal (GI) side effects than non-selective NSAIDs and were potentially useful in the treatment and prevention of different gastrointestinal and non-gastrointestinal malignancies. It was one of those long-term colon cancer prevention trials which showed that the use of rofecoxib was associated with increased incidence of vascular occlusive diseases vs. placebo [1]. Other studies have now shown that the effect observed with rofecoxib was not drug-specific, but extensive to all COX-2 selective inhibitors and probably to all non-selective NSAIDs [2,3]. Furthermore, the mechanisms behind these cardiovascular side effects are far from being clear. The COX-2 selective inhibition of endothelial derived prostacycline and the lack of inhibition of the COX-1 platelet dependent thromboxane synthesis do not fully explain the cardiovascular side effects associated with coxibs or non-selective NSAIDs. Now, more than two years after the withdrawal of rofecoxib from the market, there is a new situation and a new perspective for the use of these compounds, where many questions that were open then haven been, at least partially, answered. This issue of the Current Pharmaceutical Design Journal is written under the new perspective and focused on the effects of COX inhibition in rheumatology, in the cardiovascular system and overall in the gastrointestinal tract with an extensive update of the information available for traditional NSAIDs, celecoxib, rofecoxib and the newer coxibs available in the market. Under the general title of “COX-2 INHIBITION IN GASTROENTEROLOGY AND RHEUMATOLGY: CURRENT CHALLENGES AND PERSPECTIVES FOR THE FUTURE”, the first article is an extensive “in deep” review up to June 2006 of our current knowledge of the cardiovascular effect of COX-2 and/or COX-1 inhibition including the clinical manifestations and the mechanisms involved in those side effects. This article has been written by Prof. Badimon’s group that have made seminal contributions in the field of the cardiovascular system [4]. The next one is written by Dr. Herbert Baraf, a renowned expert on the rheumatology field, and it is mainly focused on the efficacy of the newest COX-2 selective inhibitors (etoricoxib and lumiracoxib) in patients suffering from different rheumatic conditions. The article has put the information in clear perspective when compared to non-selective NSAIDs and other COX-2 selective inhibitors and taking into account the potential side effects derived from their use [5]. From a GI perspective, Professor Richard Hunt and Dr Yuan from MacMaster University have written another extensive and outstanding review of the information available for both lumiracoxib and etoricoxib [6]. One of the most difficult questions in clinical practice is the management of patients who need NSAIDS and are taking low-dose aspirin. This is a frequent clinical situation that can be seen in more than 20% of patients who need NSAIDs. The combination of these drugs increases the risk of GI complications and probably the risk of developing cardiovascular side effects. Dr Sopena and myself have tried to put the issue in perspective and come out with practical recommendations based on the available evidence [7]......