Kardiovaskulární účinky COX-2 selektivních inhibitorů - postavení meloxikamu

COX-2 specifické inhibitory byly vyvinuty ve snaze snížit výskyt nežádoucích vedlejších úího traktu pekávaným výsledkem jedné ze studií, která byla primárndoucích úýšený výskyt kardiovaskulárních pání s pacienty lého infarktu myokardu. O pasnjším jeví kardioprotektivní vliv naproxenu, který byl prokázán. Diskutuje se i otázka možného protektivního vlivu COX-2 selektivních inhibitorkardiovaskulárních příhod v souvislosti se známým protizánětlivým vlivem COX-2 selektivních inhibitorů.

Metaanalýza studií provedených s meloxikamem neprokazuje zvýšení výskytu tromboembolických příhod v souvislosti s léčbou tímto COX-2 selektivním inhibitorem. Výsledky studie NUT-2 dokonce naznačují možný příznivý vliv meloxikamu na kardiovaskulární aterosklerotické příhody.

Cardiovascular effects of COX-2 selective inhibitors - position of meloxicam

COX-2 selective inhibitors have been developed with intention to decrease an incidence of undesirable side effects in gastrointestinal tract with analgesic and anti-inflammatory effects maintained. One of studies, focused primarily to gastrointestinal undesirable effects detection (VIGOR), showed unexpected outcome - unpredicted elevation of cardiovascular attacks in patients treated with 50 mg of rofecoxib, compared to those with 2 × 500 mg of naproxen, particularly an incidence of minor (not fatal) myocardial infarction. The ground is a matter of debate, either cardioprotective effect of naproxen or prothrombotic effect of rofecoxib are possible. Presently a cardioprotective effect of naproxen, which has been proved, seems to be more likely. Question of possible protective effect of COX-2 selective inhibitors in prevention of thrombotic cardiovascular attacks is also being discussed in connection with their known anti-inflammatory effect.

Meta-analysis of studies with meloxicam does not show increased incidence in thromboembolism connected to treatment with this COX-2 selective inhibitor. NUT-2 study shows even possible favourable action of meloxicam to cardiovascular atherosclerotic attacks.

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