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152
Lander et al.,
Lupus. 2002
Data from a retrospective,
open-labeled, cohort
study in 50 systemic lupus
erythematosus patients
seen by a community
based rheumatologist and
a MedLine search (using
MeSH headings) of all
articles pretaining to the
use of NSAIDs in patients
with systemic lupus
erythematosus since 1996.
To evaluate the safety and
efficacy of Celecoxib in
systemic lupus
erythematosus patients
both with and without a
self-reported sulfa drug
allergy and to review the
literature on the use of
NSAIDs in SLE patients.
154
Devillier P.,
Presse Med.
2001
Citing and reviewing
results from published
literature.
To give an overview of
the pharmacology of
NSAIDs and ear nose and
throat (ENT) pathology.
164
Deray G.,
Presse Med.
2001
Data from different
studies.
To review the renal
effects of NSAIDs.
• Treatment periods were 1 – 9 months.
• In the cohort of Celecoxib-treated SLE patients the majority of patients demonstrated
some improvement and little toxicity.
• SLE patients with self-reported sulfa allergies were not more likely to have adverse
reactions than non-sulfa allergic patients.
• This literature review reveals that structural dissimilarities between Celecoxib and
sulfonamide antimicrobials may make true cross-allergenicity less likely to be a clinical
problem.
→ Results suggest that patients with SLE can be safely and effectively treated with
Celecoxib.
→ Since several hundred thousand lupus patients take NSAIDs regularly, and since drug
toxicity is a major concern in SLE patients, creation of evidence-based guidelines for the
use of these agents, including COX-2 inhibitors, should be undertaken.
• No indication for anti-inflammatory action in the ENT conditions, neither for NSAIDs
nor COX-2 inhibitors.
• Official indication guideline in France concerning ENT disease in children and adults
without risk factor are that there is no need to institue NSAID treatment at an antiinflammatory dose in combination with general antibiotic therapy, except when there is
an important inflammatory component.
• NSAIDs are not indicated in nasal polyposis and contraindicated in case of intolerance
to NSAID, observed in ≈ 15-20% of patients with nasal polyposis.
• High doses, age over 60 years and history of severe GI complications are factors
increasing the risk of severe GI AEs of NSAIDs. Minor AEs and severe AEs are
significantly reduced with COX-2 inhibtors.
• In patients with asthma triggered by classical NSAIDs, COX-2 inhibitor do not trigger
acute asthma.
• COX-2 inhibitors are currently not indicated for children and not for ENT.
• Renal effects of NSAIDs in decreasing order:
Electrolyte imbalance (hyperkaliemia, edema, hypertension), acute renal failure,
nephrotic syndrome associated with interstitial nephropathy, papillary necrosis.
• Electrolyte disorders and acute renal failure are observed more frequently in patients
with risk factors.
• Some studies examining the renal effects of COX-2 inhibitors (Rofecoxib and
Celecoxib) precised the long-term effect on BP, edema, kaliemia and renal function. All
these studies, except CLASS point to the strictly identical renal effects of COX-2
inhibitors and nonselective NSAIDs.
→ Detection and avoidance of the risk factors allow a well tolerated treatment with
selective and non-selective NSAIDs. The use of COX-2 inhibitors does not optimize the
order of these risk factors.
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