Short spell of Celebrex may be safe for IBD

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In a study of patients with dormant ulcerative colitis, a 14-day course of the selective COX-2 inhibitor, Celebrex (celecoxib), did not cause disease exacerbation. However, another study showed that use of older, nonselective anti-inflammatory agents can quickly induce relapse in patients with Crohn’s disease and ulcerative colitis. However, this study also found that short-term treatment with a Celebrex-like drug or with low-dose aspirin is well tolerated.

The results of the two studies may set the stage for larger, prospective trials of COX-2 inhibitors in patients with inflammatory bowel disease (IBD), researchers say. However, such trials will most likely have to wait until the cardiovascular disease risk from COX-2 inhibitors has been clarified.

Ulcerative colitis (inflammation of the colon) and Crohn’s disease (inflammation of the digestive tract) are two forms of IBD.

IBD sufferers often require pain medication, but studies have suggested that conventional anti-inflammatory drugs, or NSAIDs, lead to increased rates of relapse in IBD patients. “In general,” Dr. William J. Sandborn told Reuters Health, “gastroenterologists have counseled patients with IBD to not take anti-inflammatory drugs. But when the COX-2 inhibitors came out, we wondered if the risk would be different.”

To investigate, Sandborn, from Mayo Clinic in Rochester, Minnesota, and colleagues randomly assigned 222 patients with ulcerative colitis in remission to Celebrex—200 mg twice daily for 14 days—or placebo.

There was no difference in rates of ulcerative colitis exacerbation between the two groups (3 percent versus 4 percent). The frequency of side effects was also no different.

“But we have yet to test celecoxib in patients in relapse, and we have not addressed the risk-benefit ratio,” Sandborn cautioned. “What our results do say is that at least in this subgroup of patients you can use COX-2 inhibitors for short-term use.”

In a separate study of patients with ulcerative colitis and Crohn’s disease in remission, Dr. Ken Takeuchi, from Guy’s, King’s, St. Thomas’ Medical School in London and associates found that nonselective anti-inflammatory agents often induce relapse but that short-term treatment with a COX-2 inhibitor or with low-dose aspirin is well tolerated.

The two studies appear in the journal, Clinical Gastroenterology and Hepatology.

The Harvard-based authors of a related editorial, conclude, “with the current information, celecoxib is safe in certain inflammatory bowel disease patients for short-term use, an important, even if small, advance.”

SOURCE: Clinical Gastroenterology and Hepatology, February 2006.

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