Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Review Article

Antiinflamatórios não esteróides inibidores da ciclooxigenase-2 (COX-2): aspectos atuais

Cycloxygenase-2 inhibitors nonsteroid anti-inflammatory drugs: current issues

Carmen Luize Kummer; Tereza Cristina R. B. Coelho

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JUSTIFICATIVA E OBJETIVOS: Devido à alta incidência de efeitos colaterais relacionados aos antiinflamatórios não hormonais (AINES), a descoberta de duas isoformas da enzima ciclooxigenase, classificadas como: COX-1 ou constitutiva e COX-2 ou indutiva, formulou o paradigma que as propriedades antiinflamatórias dos AINES seriam mediadas através da inibição da enzima COX-2; já os efeitos colaterais, do bloqueio da COX-1. Entretanto, a isoforma COX-2 tem sido detectada constitutivamente em tecidos normais, levantando a dúvida sobre o quão realmente são seguros os inibidores específicos desta enzima. O objetivo desta revisão é relatar as mais recentes evidências clínicas e experimentais envolvendo a COX-2 e os compostos inibidores desta isoforma. CONTEÚDO: São exibidos os novos conceitos sobre as diferenças estruturais entre COX-1 e COX-2, a existência destas isoformas nos diversos tecidos, os resultados de experimentos em animais e humanos, além da observação clínica dos compostos inibidores específicos COX-2 (coxibs). Algumas prováveis novas indicações de antiinflamatórios não esteróides, principalmente coxibs, na demência de Alzheimer e em neoplasias são exemplificadas. CONCLUSÕES: Os coxibs representam importante avanço farmacológico no tratamento antiinflamatório, reduzindo a incidência de lesões gastrointestinais e apresentando possível indicação na prevenção de neoplasias e doenças neurológicas. No entanto, tais compostos apresentam efeitos colaterais indistinguíveis dos AINES convencionais e são drogas de alto custo. Como toda medicação de recente lançamento no arsenal médico, maiores avaliações são necessárias para o estabelecimento da real segurança destes compostos.




BACKGROUND AND OBJECTIVES: Due to the high incidence of NSAID-related side-effects, the discovery of two cycloxygenase isoforms, classified as: COX-1 or constitutive and COX-2 or inductive, has formulated the paradigm that NSAIDs anti-inflammatory properties would be mediated by COX-2 inhibition, and side-effects, by COX-1 blockade. However, COX-2 has been constitutively detected in normal tissues raising the question of how really safe are specific inhibitors of such enzyme. This review aimed to report new clinical and experimental evidences involving COX-2 and its specific inhibitors. CONTENTS: New concepts on structural differences between COX-1 and COX-2, the existence of these isoforms in different organic tissues, and animal and human experiments are reported, in addition to clinical observations of specific COX-2 inhibitors (coxibs). Potential new therapeutic indications of NSAIDS, mainly coxibs, for Alzheimer’s disease and cancer are emphasized. CONCLUSIONS: Coxibs are an important pharmacological advance for anti-inflammatory treatment, decreasing the incidence of gastrointestinal adverse effects and probably playing a role in the prevention of cancer and neurological diseases. However, similar side-effects from conventional NSAIDs still exist, and also, coxibs are high-cost drugs. Like any new medication, further evaluations are needed to determine the actual safety profile of such compounds.




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