Woessner Katharine M, Simon Ronald A, Stevenson Donald D
Scripps Clinic and the Scripps Research Institute, La Jolla, California 92037, USA.
Arthritis Rheum. 2002 Aug;46(8):2201-6. doi: 10.1002/art.10426.
To determine whether celecoxib, a selective cyclooxygenase 2 (COX-2) inhibitor, cross-reacts in patients with aspirin-exacerbated respiratory disease (AERD) with asthma.
Sixty patients with asthma underwent double-blinded, placebo-controlled oral challenges with celecoxib (100 mg, 200 mg, and 2 placebos) over 48 hours in our General Clinical Research Center. The next day, sensitivity to acetylsalicylic acid (ASA) was proven in all patients with the use of single-blinded ASA challenges.
None of the 60 patients experienced any symptoms, changes in nasal examinations, or declines in forced expiratory volume in 1 second during the celecoxib challenges. All 60 patients experienced oculonasal and/or asthmatic reactions to ASA, with a mean provoking dose of 69 mg. The exact 1-sided confidence interval for the probability of celecoxib inducing cross-reactions in AERD patients was calculated to be between 0% and 5%.
Cross-reactivity between ASA and celecoxib does not occur in patients with AERD. These results do not preclude the possibility of other types of immune reactions occurring with celecoxib after prior exposure. Our results add to the growing body of evidence that inhibition of COX-1 is a critical initiating event in the precipitation of respiratory reactions in AERD patients following ingestion of nonsteroidal antiinflammatory drugs.
确定选择性环氧化酶2（COX-2）抑制剂塞来昔布在患有阿司匹林加重性呼吸系统疾病（AERD）并伴有哮喘的患者中是否会发生交叉反应。
60例哮喘患者在我们的综合临床研究中心接受了为期48小时的双盲、安慰剂对照口服塞来昔布（100毫克、200毫克和2种安慰剂）激发试验。次日，通过单盲阿司匹林激发试验证实所有患者对乙酰水杨酸（ASA）敏感。
在塞来昔布激发试验期间，60例患者中无一例出现任何症状、鼻检查变化或一秒用力呼气量下降。所有60例患者对ASA均出现眼鼻和/或哮喘反应，平均激发剂量为69毫克。计算得出塞来昔布在AERD患者中引起交叉反应概率的确切单侧置信区间为0%至5%。
AERD患者中ASA与塞来昔布之间不存在交叉反应。这些结果并不排除先前接触塞来昔布后发生其他类型免疫反应的可能性。我们的结果进一步证明了抑制COX-1是AERD患者摄入非甾体抗炎药后引发呼吸反应的关键起始事件。
