Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
To the Editor: The study by Dr Simon and colleagues1 found a markedly reduced frequency of upper GI
tract toxicity in subjects receiving celecoxib vs those receiving naproxen,
although the importance of that finding for predicting clinical events is
still uncertain. Nonetheless, the reason for this difference is not necessarily
that celecoxib is COX-1 sparing. The hypothesized protective role of COX-1
has obtained most of its support from the observations that several "COX-2–selective"
NSAIDs appear to have less GI tract toxicity and that administering misoprostol
also reduces the risk. But that is circumstantial evidence only, and misoprostol
has other pharmacological properties that may explain its protective effect.
Palmer RH. Cyclooxygenase 2 Selective Agents and Upper Gastrointestinal Disease. JAMA. 2000;283(15):1961-1962. doi:10.1001/jama.283.15.1957