Celecoxib for the treatment of musculoskeletal arthritis

ABSTRACT

Introduction: The cyclooxygenase (COX)-2 inhibitor celecoxib is an approved compound for rheumatoid (RA) and osteoarthritis (OA), combining both anti-inflammatory and analgesic properties with a good gastrointestinal tolerability.

Areas covered: This article covers the pharmacological properties and clinical efficacy as well as the latest safety data available for celecoxib with emphasis on the treatment of RA and OA. It is based primarily on a current literature search on PubMed and Web of Science, but also on the professional rheumatological expertise of the authors.

Expert opinion: Celecoxib has been shown to be superior to placebo and equivalent to traditional non-steroidal anti-inflammatory drugs (tNSAIDs). Many studies have been published making celecoxib a good and safe treatment option in particular in moderate arthritis and patients without established cardiovascular (CV) disease. Moreover, older patients might gain significant benefits compared to tNSAIDs due to reduced gastrointestinal events even when having a history of ulcer bleedings. Nonetheless, there is still much to learn, especially regarding the prescription of celecoxib in patients with cardiovascular co-morbidities. While low doses seem to be safe according to present data, the knowledge on the more effective, higher doses >400 mg/day is still limited.

KEYWORDS:

• Celecoxib
• coxibs
• arthritis
• pain
• NSAID

Article highlights

• This article reflects approx. 20 years of clinical experience with celecoxib.

• Most recent clinical trial data regarding efficacy as well as safety are summarised and discussed.

• Important details on the drug itself including pharmacodynamics and pharmacokinetics are presented.

• Mechanisms potentially being involved in the cardiovascular side effects of COX-2 inhibitors are further described.

• An expert opinion based on the authors' rheumatological expertise completes this article.

Authors’ contributions

MK reviewed the literature and drafted the manuscript. CB contributed important intellectual content to the manuscript and was involved in reviewing the literature. Both authors read and approved the final manuscript.

Acknowledgments

Marvin was used for drawing, displaying and characterizing chemical structures, substructures, and reactions, Marvin Version 19.2.0, 2019 ChemAxon (http://www.chemaxon.com).

Ethical approval

All procedures performed in this survey were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Data obtained in this study did not interfere with the course of treatment for patients included.

Declaration of interest

C Baerwald has received lecture fees from Merck & Co, Merck Sharp & Dohme, Mundipharma and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.