Objectives Conventional NSAIDs, which nonselectively inhibit cyclooxygenase (COX)-1 and COX-2, are associated with deleterious effects on renal function such as reductions in glomerular filtration rate and sodium retention. Celecoxib specifically inhibits COX-2. Such specific inhibition raises the possibility that the incidence of renal toxicity vs conventional NSAIDs may be reduced.
Methods In a randomised, double-blind trial with exposures of up to 15 months, 7968 patients with osteoarthritis (OA) (n = 5746) or rheumatoid arthritis (RA) (n = 2183) were randomised to receive supratherapeutic doses of celecoxib (400 mg BID; n = 3,987) vs ordinary therapeutic doses of conventional NSAIDs: ibuprofen (800 mg TID; n = 1996) or diclofenac (75 mg BID; n = 1985).
Results Fewer celecoxib-treated patients experienced renal toxicity compared to patients treated with NSAIDs (see Table 1; *p < 0.05 vs celecoxib, **serum creatinine levels above 2 mg/dL and/or BUN values above 40 mg/dL).
Conclusion Celecoxib at supratherapeutic doses was associated with a lower incidence of renal toxicity compared to conventional NSAIDs at ordinary therapeutic doses.
Sponsored by Pharmacia Corporation and Pfizer, Inc.
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