Current challenges for therapy of comorbid patients: a new look at celecoxib. A review

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Abstract

The use of non-steroidal anti-inflammatory drugs (NSAIDs) for a wide range of diseases is increasing, in part due to an increasing elderly population. Elderly patients are more vulnerable to adverse drug reactions, including side effects and adverse effects of drug-drug interactions, often occurring in this category of patients due to multimorbidity and polypharmacy. One of the most popular NSAIDs in the world is celecoxib. It is a selective cyclooxygenase (COX)-2 inhibitor with 375 times more COX-2 inhibitory activity than COX-1. As a result, celecoxib has a better gastrointestinal tract safety profile than non-selective NSAIDs. Gastrointestinal tolerance is an essential factor that physicians should consider when selecting NSAIDs for elderly patients. Celecoxib can be used in a wide range of diseases of the musculoskeletal system and rheumatological diseases, for the treatment of acute pain in women with primary dysmenorrhea, etc. It is also increasingly used as part of a multimodal perioperative analgesia regimen. There is strong evidence that COX-2 is actively involved in the pathogenesis of ischemic brain damage, as well as in the development and progression of neurodegenerative diseases, such as Alzheimer's disease. NSAIDs are first-line therapy in the treatment of acute migraine attacks. Celecoxib is well tolerated in patients with risk factors for NSAID-associated nephropathy. It does not decrease the glomerular filtration rate in elderly patients and patients with chronic renal failure. Many meta-analyses and epidemiological studies have not confirmed the increased risk of cardiovascular events reported in previous clinical studies and have not shown an increased risk of cardiovascular events with celecoxib, irrespective of dose. COX-2 activation is one of the key factors contributing to obesity-related inflammation. Specific inhibition of COX-2 by celecoxib increases insulin sensitivity in overweight or obese patients. Combination therapies may be a promising new area of treatment for obesity and diabetes.

About the authors

Sergey K. Zyryanov

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: zyryanov-sk@rudn.university
ORCID iD: 0000-0002-6348-6867
SPIN-code: 2725-9981
Scopus Author ID: 35796816700

доктор мед. наук, проф., зав. каф. общей и клинической фармакологии

Russian Federation, Moscow

Elena A. Baybulatova

Peoples' Friendship University of Russia named after Patrice Lumumba

Author for correspondence.
Email: baybulatova_ea@pfur.ru
ORCID iD: 0000-0003-3013-5697
SPIN-code: 8415-5675
Scopus Author ID: 57211403718

кандидат мед. наук, доц. каф. общей и клинической фармакологии

Russian Federation, Moscow

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2. Fig. 1. Adverse effects of COX-2-mediated signaling on obesity and insulin resistance [90].

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