Celecoxib Safe in Aspirin-Exacerbated Respiratory Disease

Laurie Barclay, MD

August 05, 2002

Aug. 6, 2002 -- The cyclooxygenase (COX)-2 inhibitor celecoxib is safe for patients with aspirin-exacerbated respiratory disease (AERD), according to the results of a double-blind, placebo-controlled challenge reported in the August issue of Arthritis & Rheumatism.

"Because of [the] potential for a severe reaction, asthmatics are usually consistently warned to avoid aspirin and NSAIDs [nonsteroid anti-inflammatory drugs] by physicians, package inserts, the Internet, nurses, pharmacists, and the press," lead author Katharine M. Woessner, from the Scripps Research Institute in La Jolla, California, says in a news release. "As a result, many patients with asthma are not receiving adequate anti-inflammatory therapy for a variety of conditions."

In this study, 60 asthmatic patients with a documented history of aspirin-provoked attacks underwent a placebo-controlled challenge with celecoxib, 100 mg and 200 mg, while being monitored for a 48-hour period. On the following day, single-blinded aspirin challenges confirmed aspirin sensitivity in all patients, with a mean provoking dose of 69 mg.

None of the patients reacted to either dose of celecoxib with respiratory-related adverse effects, changes in nasal examinations, or declines in forced expiratory volume. The probability of celecoxib inducing cross-reactions in AERD was calculated to be between 0% and 5%. However, the authors note that "these results do not preclude the possibility of other types of immune reactions occurring with celecoxib after prior exposure."

Since this study, more than 120 patients with AERD have been challenged with celecoxib without developing respiratory symptoms. The authors suggest that inhibition of COX-1 is a critical initiating event for respiratory reactions to NSAIDs in patients with AERD.

"Our data suggests that with the availability of celecoxib, this medication can be safely given to any asthmatic individual without concern that first exposure might induce an asthma attack," Woessner says.

Searle supported this study.

Arthritis Rheum. 2002;46(8): 2201-2206

Reviewed by Gary D. Vogin, MD

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