Cyclooxygenase-2: a major therapeutic advance?

The introduction of the highly selective cyclooxygenase-2 (COX-2) inhibitors (Coxibs) has resulted in the greatest new drug use ever. The hypothesis on which these drugs were developed was that COX-2–specific inhibitors would retain the advantageous aspects but restrict the deleterious effects of conventional nonsteroidal anti-inflammatory drugs (NSAIDs). Current practice and evidence suggests that bleeding from the gastrointestinal tract is reduced to the level of placebo and that dyspepsia persists, and in other areas (particularly renal side effects), COX-2–specific inhibitors still have classic NSAID problems.