Nonsteroidal Anti‐Inflammatory Therapy: A Journey Toward Safety. Issue 4 (22nd December 2016)

• Record Type: Journal Article
• Authors: Pereira‐Leite, Catarina; Nunes, Cláudia; Jamal, Sarah K.; Cuccovia, Iolanda M.; Reis, Salette
• Is Part Of: Medicinal research reviews. Volume 37:Issue 4(2017)
• Page Start: 802
• Page End: 859
• Publication Date: 2016-12-22
• Subjects: nonsteroidal anti‐inflammatory drugs -- nitric oxide -- hydrogen sulfide -- 5‐lipoxygenase -- microsomal prostaglandin E2 synthase‐1; Pharmacology -- Periodicals; Drugs -- Research -- Periodicals; 615
• DOI: 10.1002/med.21424
• Languages: English
• ISSNs: 0198-6325

Abstract

Abstract: The efficacy of nonsteroidal anti‐inflammatory drugs (NSAIDs) against inflammation, pain, and fever has been supporting their worldwide use in the treatment of painful conditions and chronic inflammatory diseases until today. However, the long‐term therapy with NSAIDs was soon associated with high incidences of adverse events in the gastrointestinal tract. Therefore, the search for novel drugs with improved safety has begun with COX‐2 selective inhibitors (coxibs) being straightaway developed and commercialized. Nevertheless, the excitement has fast turned to disappointment when diverse coxibs were withdrawn from the market due to cardiovascular toxicity. Such events have once again triggered the emergence of different strategies to overcome NSAIDs toxicity. Here, an integrative review is provided to address the breakthroughs of two main approaches: (i) the association of NSAIDs with protective mediators and (ii) the design of novel compounds to target downstream and/or multiple enzymes of the arachidonic acid cascade. To date, just one phosphatidylcholine‐associated NSAID has already been approved for commercialization. Nevertheless, the preclinical and clinical data obtained so far indicate that both strategies may improve the safety of nonsteroidal anti‐inflammatory therapy.