A Comparative Study of The Effect of Selectivity of COX-2 Inhibition (Meloxicam & Celecoxib) on Some Cardiovascular RiskMarkers in Patients With Rheumatoid Arthritis

Abstract

Background: Prostaglandin G/H Synthases (Cyclooxygenases) are enzymesthat catalyze the conversion of arachidonic acid to a series of compounds endingin prostaglandins, endogenous compounds triggering many biological &physiological events in many systems including circulatory & renal systems.The normal balance between Cox-1 derived thromboxane A2 (TXA2) whichacts as a platelet activator enhancing thrombosis, & the antithromboticcardioprotective effects of prostacyclin (PGI2) which is produced through Cox-2activity. Thus inhibition of Cox-2 derived PGI2 will exaggerate thecardiovascular effects of TXA2. Cyclooxygenase - 2 (Cox-2) inhibitors havedifferent odds on cardiovascular risk factors through selectivity to that enzymethat could play a role in their pharmacological action.Objective: Our study includes a comparison between the effects of the purelycox-2 selective inhibitor (Celecoxib), and the relatively Cox-2 selective inhibitor(Meloxicam) on some cardiovascular risk markers in patients suffering fromrheumatoid arthritis.Materials &Methods: Thirty –six patients were selected as having rheumatoidarthritis (RA) with age range of 30-60 years (48±9.72), in addition to a group ofnormal subjects (12) were included as a control group Specific biochemicalinvestigations based on measuring highly sensitive kit for serum C – reactiveprotein (hs-CRP), serum creatine kinase( CK), serum aspartateaminotransferase(AST), serum urea, serum creatinine, and serum lipid profile.The patients were treated with celecoxib 400mg/day or with meloxicam15mg/day for 3 months period.Results: Both drugs were able to reduce (significantly) the highly sensitive Creactiveprotein and increase serum total cholesterol, Low Density Lipoprotein/High Density Lipoprotein (LDL/HDL) ratio as compared pretreatment values.Both drugs have nearly the same effects on renal function presented bydecreasing glomerular filtration rate (GFR) as indicated by elevating serum urealevels.Conclusion: The selectivity of COX2 inhibition is not the major character thatcould be correlated with cardiovascular events related to their administration.Since, meloxicam could aggravate some cardiovascular risk factors more thancelecoxib does, as presented a significant increment in serum CK activity.Keywords: Meloxicam,Celicoxib,Cardiovascular risk markers, CRP,Rheumatoid arthritis.