Discussion on rofecoxib, a COX-2 inhibitor, does not inhibit human gastric mucosal prostaglandin production

Abstract

Background & Aims: Rofecoxib, an inhibitor of the inducible cyclooxygenase (COX)-2 enzyme, appears not to cause acute gastroduodenal injury or chronic ulceration. To attribute this to COX-2 selectivity with sparing of gastric mucosal prostaglandin synthesis requires direct proof. Methods: Twenty-four healthy, nonsmoking Helicobacter pylori-negative volunteers were randomized to 1 of 2 separate concurrent blinded crossover studies. Sixteen volunteers received rofecoxib, 50 mg once daily, for 5 days in one treatment period and placebo in the other. Eight volunteers similarly received naproxen, 500 mg twice daily, and placebo. On day 5 of each period, antral mucosal prostaglandin E2 (PGE2) synthesis was measured by radioimmunoassay after vortexing for 3 minutes. Whole blood COX-1 activity was measured as serum thromboxane (TXB)2- and COX-2 activity as lipopolysaccharide (LPS)-induced PGE2. Results: Naproxen decreased gastric mucosal PGE2 synthesis by 65% (90% confidence interval [Cl], 53%-74%; P = 0.001 vs. placebo) in contrast to an 18% increase after rofecoxib (90% Cl, -11% to 57%; P = 0.313 vs. placebo). Naproxen also significantly inhibited both serum TXB2 by 94% and LPS-induced PGE2 production by 77% (both P ≤ 0.002 vs. placebo), but rofecoxib only inhibited COX-2-dependent LPS-induced PGE2 (by 79%; P < 0.001 vs. placebo). Conclusions: Rofecoxib (50 mg) lacked naproxen's ability to reduce the availability of gastroprotective prostaglandins.