Novel nonsteroidal anti-inflammatory drugs

The authors first briefly review how the concept of COX-2 selectivity was b rought to light, then tested against the known gastrotoxicity ranking of cu rrently used NSAIDs, from the old classics to the most recent. One truly selective COX-2 agent - celecoxib - is now being marketed in an e ver increasing number of countries. So far ait seems to keep its main promi ses, i.e. high - albeit not total - safety regarding gastrointestinal adver se effects, and undisturbed platelet function. Association with warfarin dr ugs seems to raise no problems, but one should still be wary of possible re nal side-effects. Efficacy, at least as assessed in osteoarthritis and rheu matoid patients, appears satisfactory. However, treatment of intense inflam matory crises, such as gout or ankylosing spondylitis, has not been assesse d, as yet. Another COX-2 agent - rofecoxib - is on the brink of being released. Its ev en more potent COX-2 selectivity raises new issues. What about some COX-1 a ctivity that several authors detected in rheumatic synovitis ? On the other hand, in particular circumstances, organs such as the stomach, the kidney and small blood vessels, seem to have their homeostasis partly controlled b y COX-2 mechanisms also. These questions should be answered soon, whilst cl inical experience with the COX-2 agent builds up.