Should selective Cox-2 inhibitors be used more?

The discovery of inducible cyclooxygenase-2 enzyme led to the development of a new generation of nonsteroidal antiinflammatory drugs, most commonly known as coxibs. Within a short span of time, coxibs became the most widely prescribed drugs (with annual sale of more than $5 billion in the US) due to their gastroprotective effect. But immediate and voluntarily withdrawal of rofecoxib due to excessive cardiac morbidity reported with its chronic use has raised questions about their superior overall safety profile. This review summarizes the evidence regarding the use of coxibs and associated cardiovascular risk; mechanisms underlying the coxibs-mediated cardiovascular risk and other thrombotic events, evidence for a differential effect on cardiotoxicity among coxibs, and recent trends in the antiinflammatory therapy.