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ALLERGY

Safety of COX-2 Inhibitors in Asthma Patients with Aspirin Hypersensitivity

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL

Cristina Fernández, PharmD

Pharmacy Practice Resident, Clinical Associate, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago

Reprints: Patricia M West PharmD BCPS, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood St. (M/C 886), Chicago, IL 60612-7230, FAX 312/996-0448, pwest{at}uic.edu

OBJECTIVE: To review the safety of cyclooxygenase-2 (COX-2) inhibitors in asthma patients with aspirin hypersensitivity.

DATA SOURCES: Clinical studies were identified using MEDLINE (1966-September 2002). Key search terms included cyclooxygenase inhibitors, aspirin, asthma, and hypersensitivity. English-language articles were identified and included. References from the identified articles were also reviewed.

DATA SYNTHESIS: The literature provides information regarding the safety of COX-2 inhibitors in asthma patients with aspirin-exacerbated respiratory disease (AERD). The mechanism of AERD involves inhibition of cyclooxygenase, particularly COX-1. Inhibition of COX-1 causes an increased production of certain inflammatory mediators, which results in the reactions seen with AERD. Considering this mechanism, COX-2 inhibitors may be an alternative to aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) in a patient with AERD. This article analyzes 4 studies to evaluate the safety of COX-2 inhibitors in this population.

RESULTS: The 4 studies evaluated included a total of 172 patients with AERD. All patients included demonstrated intolerance to aspirin or NSAIDs and tolerated the selective COX-2 inhibitor administered.

CONCLUSIONS: COX-2 inhibitors provide a potentially safe alternative for treatment of inflammatory conditions in patients with AERD.

Key Words: aspirin, asthma, COX-2 inhibitors

Published Online, August 15, 2003. www.theannals.com, DOI 10.1345/aph.1C497

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-032-H01

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