Drug Comparisons

COX-2 inhibitors are the newest type of non-steroidal anti-inflammatory drugs (NSAIDs) to be approved by the U.S. Food and Drug Administration (FDA). The older (also called traditional) NSAIDs?such as ibuprofen and naproxen?are effective at relieving pain and inflammation associated with arthritis. However, long-term use of traditional NSAIDs can increase the risk of developing stomach ulcers or kidney problems.

COX-2 inhibitors work by blocking only one type of an enzyme known as cyclooxygenase (COX) rather than blocking both major types of COX (COX-1 and COX-2), as the traditional NSAIDs do. COX-1 is involved in many body functions, including protection of the gastrointestinal (GI) tract and some kidney processes; while COX-2 primarily is involved in inflammation. Therefore, COX-2 inhibitors generally relieve pain and inflammation as effectively as traditional NSAIDs, but their GI and kidney side effects may be less than with the traditional NSAIDs.

Drugs in this Class
Celecoxib Capsules (Celebrex)

Summarizing the Evidence

• Celebrex, the only COX-2 inhibitor currently on the U.S. market, has been shown in clinical studies and from general use to be effective in reducing inflammation and relieving pain from arthritis. Because Celebrex was approved in 1999, a significant amount of clinical evidence supports its effectiveness.
• Many of the comparative trials for COX-2 inhibitors in treating arthritis were conducted with the first approved drug in the class, Vioxx (rofecoxib) or with a second-generation COX-2, Bextra (valdecoxib). More than 3 years after its approval, Vioxx was withdrawn from the market due to dangerous side effects, including heart attacks and strokes, which possibly were associated with its use. In April 2005, U.S. sales of Bextra, which was FDA-approved in November 2001, were also suspended.
• One relatively small study compared Celebrex, Vioxx, and a placebo (inactive sugar pill) in 182 adult patients with osteoarthritis (OA) of the knee. Celebrex and Vioxx showed comparable results?both drugs were similarly effective in relieving OA pain.
• Two other studies of Celebrex, Vioxx, and placebo involved over 800 patients with OA of the knee. During the 6 weeks that the identical studies lasted, both Celebrex 200mg and Vioxx 12.5 mg were more effective than placebo?showing approximately equal relief of OA pain.
• Another study compared Celebrex, Vioxx, and acetaminophen (Tylenol) in 400 adults with OA. The study showed slightly better results with Vioxx compared to Celebrex and acetaminophen for relieving pain and morning stiffness. However, this study was funded and carried out in part by the pharmaceutical company that makes Vioxx, and the results may have been influenced by that funding source.
• A larger study (1578 OA patients) comparing Celebrex, two doses of Vioxx, and acetaminophen showed similar results. This study found that 200 mg of Celebrex, 12.5 mg of Vioxx, and 25 mg of Vioxx per day all relieved OA pain more effectively than 4,000 mg of acetaminophen per day. Relief from the higher dose of Vioxx was somewhat faster and slightly greater than with Celebrex or with the lower dose of Vioxx.
• Two related 6-week studies also measured the ability of Celebrex, Vioxx, and placebo to alleviate pain at night for patients with OA of the knees, hips, or both. Although one study found that results from taking Vioxx were slightly better than Celebrex, the second study found no substantial difference between Vioxx and Celebrex.

Dosing and Administration

Celebrex can be taken either once daily or twice daily for treating arthritis.

Cautions

Taking a COX-2 inhibitor may increase the risk of having an adverse cardiovascular event such as a heart attack or a stroke. Vioxx was associated with more reported cases of such serious adverse events than other COX-2 inhibitors. Many of the adverse events happened within a few months of beginning treatment with the COX-2 inhibitor. Additionally, the risk appears to increase as the dose of COX-2 inhibitor increases. More studies are needed to determine whether all COX-2 inhibitors (including Celebrex) increase cardiovascular risk.

Rarely, taking Celebrex has been associated with an allergic reaction (usually a skin rash) for patients who are also allergic to salicylate drugs, such as aspirin.

Generic Availability

Currently, Celebrex is not available generically. However, many traditional NSAIDs are available not only as generics, but also as non-prescription (also called over the counter or OTC) products. For many arthritis patients, a generic traditional NSAID?either prescription or OTC?may be an effective, more affordable treatment option than Celebrex.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

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Last Updated: June 2005
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