Despite the considerable range of newly identified disease modifying approaches to the control of the inflammatory process reported over the past 10–20 years, only a few have yet gained widespread clinical acceptance. In contrast, the very recent advent of the class of anti-inflammatory agents termed COX-2 selective inhibitors is already having a significant impact on current clinical prescribing practice and market share in those territories that they are available.

That these COX-2 selective inhibitors have become so successful within the same year of their launch attests to the perceived need for novel agents that can control the signs and symptoms of inflammatory diseases, but with minimal risk of gastrointestinal side effects. Extensive epidemiological studies have well documented the so-called stealth epidemic of the gastropathy with non-steroidal anti-inflammatory drugs (NSAIDs) that has developed over the period since the non-aspirin NSAIDs were introduced.1 ,2 The massive growth of the market for such products, which has involved different patients populations and the prescription of high doses, has led to the current substantial problem of some 103 000 hospitalisations and 16 500 deaths per year in the USA alone. The impact of such events on health care budgets is therefore substantial, and the risk of serious side effects from these agents is an important consideration in long term anti-inflammatory therapy, especially in the elderly. Individual assessment of personal risk from taking NSAIDs can be obtained from a questionnaire accessed at www.seniors.org/score.

This initial success of the COX-2 selective agents, unprecedented in the area of anti-inflammatory analgesics, has probably arisen from the general perception that they are a superior form of non-steroidal anti-inflammatory drug rather than a completely novel therapeutic approach of unknown clinical consequences. Moreover, the very reasonable scientific rationale proposed for their enhanced safety has been backed up by relatively extensive …