Laine Loren, White William B, Rostom Alaa, Hochberg Marc
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Semin Arthritis Rheum. 2008 Dec;38(3):165-87. doi: 10.1016/j.semarthrit.2007.10.004. Epub 2008 Jan 4.
To assess the efficacy of cyclooxygenase-2 selective inhibitors (coxibs) in osteoarthritis (OA) and their gastrointestinal, cardiovascular, renovascular, and hepatic side effects compared with traditional nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen.
Bibliographic database searches for randomized controlled trials, meta-analyses, and literature reviews.
Coxibs are comparable to traditional NSAIDs, providing moderate benefit for OA patients in pain and function versus placebo. NSAIDs, including coxibs, are superior to acetaminophen for OA, particularly in patients with moderate to severe pain. Coxibs decrease gastroduodenal ulcers (74% relative risk reduction) and ulcer complications (61% reduction) versus traditional NSAIDs. Meta-analysis of randomized trials indicates that coxibs increase the risk of myocardial infarctions approximately twofold versus placebo and versus naproxen, but do not increase the risk versus nonnaproxen NSAIDs. NSAIDs, including coxibs, commonly cause fluid retention and increase blood pressure and uncommonly induce congestive heart failure or significant renal dysfunction; risk factors include advanced age, hypertension, and heart or kidney disease. NSAIDs are a rare cause of clinical hepatotoxicity (<1 liver-related death per 100,000 NSAID users in clinical studies). Increased rates of aminotransferase elevations occur with rofecoxib (2%) and high-dose lumiracoxib (3%), and postmarketing cases of clinical liver injury with lumiracoxib have been reported recently.
Coxibs are as effective as traditional NSAIDs and superior to acetaminophen for the treatment of OA. Coxibs cause fewer gastrointestinal complications than traditional NSAIDs. Coxibs increase cardiovascular risk versus placebo and naproxen-but probably not versus nonnaproxen NSAIDs. Blood pressure commonly increases after initiation of selective or nonselective NSAIDs, especially in hypertensive patients.
评估环氧化酶-2选择性抑制剂（昔布类药物）治疗骨关节炎（OA）的疗效及其与传统非甾体抗炎药（NSAIDs）和对乙酰氨基酚相比的胃肠道、心血管、肾血管和肝脏副作用。
检索文献数据库以查找随机对照试验、荟萃分析和文献综述。
昔布类药物与传统NSAIDs疗效相当，与安慰剂相比，能为OA患者的疼痛和功能带来适度改善。包括昔布类药物在内的NSAIDs治疗OA优于对乙酰氨基酚，尤其在中重度疼痛患者中。与传统NSAIDs相比，昔布类药物可减少胃十二指肠溃疡（相对风险降低74%）和溃疡并发症（降低61%）。随机试验的荟萃分析表明，与安慰剂和萘普生相比，昔布类药物使心肌梗死风险增加约两倍，但与非萘普生NSAIDs相比，并未增加风险。包括昔布类药物在内的NSAIDs通常会导致液体潴留、血压升高，很少诱发充血性心力衰竭或严重肾功能不全；危险因素包括高龄、高血压以及心脏或肾脏疾病。NSAIDs是临床肝毒性的罕见原因（临床研究中每10万名NSAIDs使用者中与肝脏相关的死亡少于1例）。罗非昔布（2%）和高剂量鲁米昔布（3%）会使转氨酶升高率增加，最近有关于鲁米昔布上市后临床肝损伤病例的报道。
昔布类药物治疗OA与传统NSAIDs同样有效，且优于对乙酰氨基酚。昔布类药物引起的胃肠道并发症少于传统NSAIDs。与安慰剂和萘普生相比，昔布类药物会增加心血管风险，但与非萘普生NSAIDs相比可能不会。开始使用选择性或非选择性NSAIDs后，血压通常会升高，尤其是高血压患者。
