Healio Rheuminations

NSAIDs, Part 3: The rise, fall and rise again of COX-2 inhibition


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In the third episode of the NSAIDs saga, we focus on COX-2 inhibition! Did the hopes and dreams of selective COX-2 inhibition pan out? What can the rise and fall of VIOXX teach us about physiology?

  • Intro 0:11
  • Recap of part 1 & 2 0:28
  • In this episode 1:44
  • Cyclooxygenase 2 (COX-2) and the rat experiment 3:12
  • What do we know about the prostaglandins? And what about COX-2 7:54
  • What does prostacyclin do? 10:33
  • The first COX-2 inhibitor: VIOXX 10:56
  • What is COX-2 doing?: Pfizer and Merck 12:15
  • Two more NSAID studies: colon cancer, Alzheimer’s disease and COX-2 inhibitors 18:41
  • VIOXX: Why is myocardial infarction risk occurring? 22:34
  • Animal models and the Goldilocks theory of thromboxane and prostacyclin 23:49
  • PRECISION trial 30:25
  • Rheum + Boards 37:14 
  • Thanks for listening 37:32

We’d love to hear from you! Send your comments/questions to Dr. Brown at [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum.

References:

Anderson GD, et al. J Clin Invest. 1996;doi:10.1172/JCI118717.

Funk CD, et al. J Cardiovasc Pharmacol. 2007;doi:10.1097/FJC.0b013e318157f72d.

Hennan JK, et al. Circulation. 2001;doi:10.1161/hc3301.092790.

Krumholz HM, et al. BMJ. 2007;doi:10.1136/bmj.39024.487720.68.

Nissen SE, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1611593.

Disclosures: Brown reports no relevant financial disclosures.

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Healio RheuminationsBy Adam J. Brown, MD

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