Celecoxib

• this is a non-steroidal anti-inflammatory agent which is a specific inhibitor of enzyme cyclo-oxygenase 2. Celecoxib is licensed for the symptom relief in rheumatoid arthritis and osteoarthritis (1)
  
• the sparing of the COX-1 isoenzyme should, in theory, result in reduced gastrointestinal side-effects and improves tolerability. However the evidence that COX-2 selectivity reduces the risk of serious upper gastrointestinal side effects, particularly gastrointestinal bleeding and ulcer perforation, points towards some reduction of risk but the advantage over conventional non-steroidal anti-inflammatory drugs appears small (2)
  
  there is evidence that celecoxib has an anti-inflammatory effect as potent as diclofenac in the treatment of rheumatoid arthritis (3)

Note - like all NSAIDs, celecoxib carries a warning for cardiovascular risk, including an increased risk of heart attacks and strokes. As a selective COX-2 inhibitor, celecoxib also faces scrutiny for increased cardiovascular risk due to another selective COX-2 inhibitor, rofecoxib, being withdrawn from production in 2004 due to cardiovascular risk concerns. Extensive reviews have had mixed results regarding whether celecoxib carries non-inferior or increased cardiovascular risk compared to ibuprofen and naproxen. (4)

Reference

1. McCormack PL. Celecoxib: a review of its use for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. Drugs. 2011 Dec 24;71(18):2457-89.
2. García-Rayado G, Navarro M, Lanas A. NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs. Expert Rev Clin Pharmacol. 2018 Oct;11(10):1031-1043.
3. Roumie CL et al. Non-aspirin NSAIDs, cyclooxygenase-2 inhibitors and risk for cardiovascular events-stroke, acute myocardial infarction, and death from coronary heart disease. Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1053-63.
4. Nissen SE. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. N Engl J Med. 2017 Apr 06;376(14):1390