NSAIDs, Part 3: The rise, fall and rise again of COX-2 inhibition

In the third episode of the NSAIDs saga, we focus on COX-2 inhibition! Did the hopes and dreams of selective COX-2 inhibition pan out? What can the rise and fall of VIOXX teach us about physiology? Intro 0:11 Recap of part 1 & 2 0:28 In this episode 1:44 Cyclooxygenase 2 (COX-2) and the rat experiment 3:12 What do we know about the prostaglandins? And what about COX-2 7:54 What does prostacyclin do? 10:33 The first COX-2 inhibitor: VIOXX 10:56 What is COX-2 doing?: Pfizer and Merck 12:15 Two more NSAID studies: colon cancer, Alzheimer's disease and COX-2 inhibitors 18:41 VIOXX: Why is myocardial infarction risk occurring? 22:34 Animal models and the Goldilocks theory of thromboxane and prostacyclin 23:49 PRECISION trial 30:25 Rheum + Boards 37:14  Thanks for listening 37:32 We'd love to hear from you! Send your comments/questions to Dr. Brown at [email protected]. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Anderson GD, et al. J Clin Invest. 1996;doi:10.1172/JCI118717. Funk CD, et al. J Cardiovasc Pharmacol. 2007;doi:10.1097/FJC.0b013e318157f72d. Hennan JK, et al. Circulation. 2001;doi:10.1161/hc3301.092790. Krumholz HM, et al. BMJ. 2007;doi:10.1136/bmj.39024.487720.68. Nissen SE, et al. N Engl J Med. 2016;doi:10.1056/NEJMoa1611593. Disclosures: Brown reports no relevant financial disclosures.