COX-2 Inhibitors — A Lesson in Unexpected Problems

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Abstract
This issue of the Journal contains three articles about the adverse cardiovascular effects of agents that selectively inhibit one form of prostaglandin endoperoxide synthase, commonly known as cyclooxygenase-2 (COX-2).13 This is part of a long bench-to-bedside story with an adverse outcome that was not widely anticipated at its start. Unfortunately, as the evidence began to suggest unexpected toxicity of this group of agents, the same zeal that had driven the clinical investigation to show their gastrointestinal safety was not evidenced by studies designed to show their cardiovascular safety.In 1987, evidence emerged4 that there were probably two enzymes — . . .