Zusammenfassung
Nichtselektive und selektive Cyclooxygenaseinhibitoren (Coxibe) sind potente Analgetika
und Antiphlogistika und werden erfolgreich bei der Therapie degenerativer und entzündlich-rheumatischer
Gelenkerkrankungen eingesetzt. Traditionelle NSAR und Coxibe unterscheiden sich dabei
nicht wesentlich in der analgetischen Potenz. Bei der Wahl dieser Prostaglandinsynthesehemmer
sollte jedoch eine individuelle patientenorientierte Nutzen-Risiko-Abwägung erfolgen.
Kardiovaskuläre und gastrointestinale Risikofaktoren sind dabei für eine differenzialtherapeutische
Entscheidung von großer Bedeutung. Bei Patienten mit beiden Risikokonstellationen,
Herzinsuffizienz, Leberzirrhose oder renalen Erkrankungen sollte auf eine Behandlung
mit COX-Inhibitoren verzichtet und Analgetika anderer Substanzklassen eingesetzt werden.
Mithilfe von Studien muss in Zukunft eine individuelle, auf den Patienten zugeschnittene,
Evidenz-basierte Therapie und damit ein Konzept zum differenzialtherapeutischen Einsatz
der nichtselektiven und selektiven COX-Hemmer in der Rheumatologie entwickelt werden.
Abstract
Non-selective and selective Cyclooxygenase inhibitors (coxibs) are potent analgesics
and antiphlogistics and are successfully used in treatment of degenerative and inflammatory
joint diseases. Traditional non-steroid anti-inflammatory drugs (NSAID) do not differ
from coxibs in their analgesic effects. Physicians should analyse the risks and benefits
of prescribing inhibitors of prostaglandin synthesis for each individual patient,
especially focusing on both the gastrointestinal and cardiovascular risks. Patients
with both risks, heart failure and liver cirrhosis or renal diseases should not be
treated with COX-inhibitors. Other analgesic agents should be chosen. Studies must
clarify which therapy is appropriate for individual patients to develop an evidence-based
concept for the differential use of traditional NSAID and coxibs in rheumatology.
Schlüsselwörter
Cyclooxygenaseinhibitoren - Coxibe - NSAR - Schmerz
Key words
cyclooxygenase inhibitors - coxibs - NSAID - pain
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Korrespondenzadresse
Dr. Susette Ilona Unger
Universitätsklinikum Leipzig
Medizinische Klinik II
Liebigstraße 20
04103 Leipzig
Telefon: +49/0341/972 4353
Fax: +49/0341/972 4849
eMail: Susette.Unger@medizin.uni-leipzig.de
