The problem with NSAIDs: What data to believe?

Abstract

Patients with rheumatoid arthritis and osteoarthritis have relied upon NSAIDs as a cornerstone of their analgesic regime for decades. The choice of anti-inflammatory agents broadened for this group of patients when the selective inhibitors of cyclooxygenase-2 enzyme were developed. Much has been published in the past few years regarding the superior gastrointestinal safety of this class of drugs when compared with traditional NSAIDs. Their triumphant debut was swiftly followed by the emergence of data detailing their associated increased serious cardiovascular risks. This also led to a reevaluation of data concerning more traditional NSAIDs, and surprisingly, a similar trend was seen. The US Food and Drug Administration has recommended that both classes of drugs carry a black box warning with regard to gastrointestinal and cardiovascular risks.

Anti-inflammatory effects of Scutellaria baicalensis extract via suppression of immune modulators and MAP kinase signaling molecules

“…Pharmacological options for the treatment of inflammatory diseases that are often chronic are associated with severe side effects. Thus the search for less toxic yet equally efficacious compounds is an area of intense research (Mckellar et al, 2007). A myriad of studies have already been conducted to screen the potent mediators of anti-inflammatory responses, as well as many compounds, despite some unfavorable effects, from clinical practice (Sonis, 2002(Sonis, , 2004Molla and Panes, 2007;Rödel et al, 2007).…”

Anti-inflammatory effect of allylpyrocatechol in LPS-induced macrophages is mediated by suppression of iNOS and COX-2 via the NF-κB pathway

“…Pharmacological options for the treatment of inflammatory diseases that are often chronic are associated with severe side effects, and therefore the search for less toxic yet equally efficacious compounds is an area of intense research [3]. Piper betle (Piperaceae), a perennial climber, has its ethno medicinal properties traced back to Sanskrit literature as early as 3000 B.C.…”

Long-chain carboxychromanols, metabolites of vitamin E, are potent inhibitors of cyclooxygenases

“…Chronic inflammation has been identified as a significant factor in the development of cancer (5). It is well established that NSAIDs are effective chemoprevention agents for cancer (6), although their long-term use has been questioned due to the associated gastrointestinal side effects and increased risk of cardiovascular diseases (7,8).Vitamin E comprises eight lipophilic antioxidants: ␣-, ␤-, ␥-and ␦-tocopherol (␣-, ␤-, ␥-, and ␦-T) and ␣-, ␤-, ␥-, and ␦-tocotrienol (␣-, ␤-, ␥-, and ␦-TE) (Fig. 1A).…”

“…Chronic inflammation has been identified as a significant factor in the development of cancer (5). It is well established that NSAIDs are effective chemoprevention agents for cancer (6), although their long-term use has been questioned due to the associated gastrointestinal side effects and increased risk of cardiovascular diseases (7,8).…”