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COX-2 Inhibitors Are Safe in Patients with Aspirin-Exacerbated Respiratory Disease

Summary and Comment |
July 24, 2014

COX-2 Inhibitors Are Safe in Patients with Aspirin-Exacerbated Respiratory Disease

  1. David J. Amrol, MD

A meta-analysis shows that AERD patients usually will tolerate celecoxib better than meloxicam.

  1. David J. Amrol, MD

The triad of asthma, aspirin sensitivity, and nasal polyposis is known as aspirin-exacerbated respiratory disease (AERD). AERD is caused by inhibition of the cyclooxygenase (COX)-1 enzyme, which, in susceptible patients, causes high cysteinyl leukotriene levels and resulting asthma and rhinitis symptoms. All nonsteroidal anti-inflammatory drugs (NSAIDs) carry an FDA contraindication for patients with AERD, but such patients usually tolerate COX-2 inhibitors.

To examine the safety of COX-2 inhibitors (i.e., celecoxib and rofecoxib) or traditional NSAIDs with relatively high COX-2 selectivity (e.g., meloxicam) in AERD patients, researchers analyzed 14 blinded, placebo-controlled trials (426 patients). No patient who received COX-2 inhibitors reported AERD symptoms; such symptoms were reported by about 8% of those who received relatively selective drugs such as meloxicam.

Comment

Traditional NSAIDs with relatively high COX-2 selectivity are 10 times more selective for COX-2 than for COX-1, whereas COX-2 inhibitors are >100 times more selective for COX-2. In AERD patients who require anti-inflammatory or analgesic agents other than low-dose acetaminophen, celecoxib is a safe option. If price is a barrier, most patients will tolerate meloxicam, but, because life-threatening reactions can occur, meloxicam should be given to AERD patients only in facilities that are prepared to treat severe respiratory reactions.

  • Disclosures for David J. Amrol, MD at time of publication Equity Abbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health Leadership positions in professional societies Allergy Society of South Carolina (Past President)

Citation(s):

Reader Comments (3)

alan garcia gtz Medical Student, GDL

the best article of asthma

Marc Baskin Physician, Allergy/Immunology

As I understand, anaphylaxis is a different animal than an acute respiratory reaction in AERD syndrome and it may not be safe to use a cox 2 inhibitor.
It is correct that a LTA preferably enzyme inhibitor (ie. Zyflo) provides added safety to a ASA challenge in AERD

DARRELL MCINDOE Physician, Internal Medicine, retired

This is signifigant information. As a person who had anaphylaxis to aspergum as a teenager and subsequent angioneurotic edema and giant urticaria to codeine, this solves my dilemma. I recently developed a fixed drug reaction to Tylenol and Darvon which I have used for years is no longer available. I will plan on using celecoxib the next time I need an analgesic, but have epinephrine handy. Would it also be wise to consider using montelukast on a chronic basis?

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