| Sumario: | In this review article we undertake an assessment of the comparative performance of cyclooxygenase-2 (COX-2) selective agents in managing nonarthritic conditions. Clinical and in-vivo reports were identified through the use of the computer databases MEDLINE and EMBASE. Our findings reveal that, generally, clinical evidence for the effectiveness of COX-2 selective agents in the treatment of nonarthritic conditions is either equivocal or lacking. In the management of postoperative dental pain, rofecoxib 50 mg exhibits analgesic efficacy comparable with that of ibuprofen 400 mg. For celecoxib 200 mg, analgesic efficacy appears comparable with that of aspirin 650 mg, but less than that of ibuprofen 400 mg or rofecoxib 50 mg. In addition to the probability of a type II statistical error in some of these studies, we also present novel arguments for previously unconsidered sources of confounding. In-vivo outcomes using established animal models of clinical pain are consistent with limited clinical utility. SC-58125 and SC-236 at the highest dose employed failed to alter the second phase of the formalin test, and NS-398, nimesulide, and L-745337 had no effect upon writhings induced by intraperitoneal acetic acid. Overall, we conclude that at present there are insufficient grounds for assuming analgesic equivalence between COX-2 selective and dual inhibitors across a wide range of acute tonic pains. For many pains, in order to achieve maximal analgesia, inhibition of both COX isoenzymes appears to be requisite.
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