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How well does celecoxib (Celebrex) work for treating rheumatoid arthritis and how safe is it?
To answer this question, scientists working with the Cochrane Musculoskeletal Group found and analyzed five high quality studies. These studies include over 10 500 people, aged 18 or more, with rheumatoid arthritis (RA) or osteoarthritis (OA). Most people received 100, 200 or 400 mg of celecoxib twice a day over 3 to 6 months. These studies provide the best evidence we have today.What is celecoxib
(Celebrex)?
Celecoxib (Celebrex) is often referred to as a 'COX
II inhibitor' and is one of the new non-steroidal anti-inflammatory drugs
(NSAIDs) prescribed to decrease pain and inflammation in rheumatoid
arthritis. Other NSAIDS, such as naproxen (Naprosyn) or diclofenac,
are also prescribed but they come with warnings that they may cause digestive
side effects such as ulcers, bleeds and perforations that can be serious.
Celecoxib is thought to be safer on the stomach than other NSAIDS but can be
more expensive.
How well does it work?
The
studies show that more people with RA who took celecoxib for up to 12 weeks had
relief from their symptoms than people who took a 'sugar pill' or placebo.
In fact, people showed a 20% improvement in the number of tender and swollen
joints plus a 20% improvement in at least three out of five other measures such
as the level of pain they reported, the level of disease activity they
described, their ability to do everyday activities, their physical check-up and
their results on blood tests.
The studies also show that celecoxib worked just as well as other NSAIDs, such as naproxen and diclofenac, over 12 weeks or 6 months.
It is also interesting to note that the studies show that people did not benefit more with larger doses of celecoxib. More research needs to be done to understand this.
How safe is it?
As to whether
celecoxib causes fewer digestive side effects like ulcers - fewer people taking
celecoxib for 3, 6 or 12 months had ulcers than people who took other NSAIDs
(naproxen, diclofenac or ibuprofen).
For periods longer than 12 months, there is some evidence that celecoxib may not be safer on the stomach than other NSAIDs and more research over longer periods of time needs to be done.
There is also some evidence in the studies that for people who take aspirin for heart problems (who may have a higher risk of ulcers) celecoxib may not be safer on the stomach than other NSAIDs.
What is the bottom
line? Celecoxib does not appear to be safer than other
NSAIDs for people who already have a higher risk of stomach and intestinal
problems, like those people taking aspirin for heart problems. People with RA, who will likely take celecoxib for a
prolonged period, may want to balance the cost of celecoxib with the uncertainty
about whether celecoxib is safer on the stomach than other NSAIDs over the long
term. Click here
for a more detailed version of this summary. From the Cochrane Systematic Review by Garner S,
Fidan D, Frankish R, Judd M, Shea B, Towheed T, Wells G, Tugwell P. Celecoxib
for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4
2002. Oxford: Update Software.
Celecoxib works just as well as other NSAIDs to
reduce pain and inflammation in RA. It is safer on the stomach than
other NSAIDs in the short term, but it is uncertain whether it is safer in
the long term.
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This page was last reviewed/updated on : 05/12/2008