9 Anti-inflammatory and antipyretic analgesics and drugs used in gout

Publisher Summary This chapter discusses the anti-inflammatory and antipyretic analgesics and drugs used in gout. Selective inhibitors of the cyclo-oxygenase type 2 isoenzyme were developed with the expectation that their use would be accompanied by a reduction in the severe gastrointestinal and renal adverse effects associated with conventional non-steroidal anti-inflammatory drugs. The adjudication analysis confirmed the first impression of an increased risk of severe cardiovascular events in patients taking rofecoxib. It is found that those who took rofecoxib also had higher risks of nonadjudicated cardiovascular events compared with those who took placebo. The Kaplan–Meier curves for the cumulative incidence of congestive heart failure, pulmonary edema, and cardiac failure showed an early separation of the two groups, at about 5 months. In two retrospective re-analyses of randomized controlled trial data for celecoxib the cardiovascular events in patients enrolled in the CLASS study were examined, as were those reported across the entire controlled arthritis clinical trial database for celecoxib. The results of the reanalysis of CLASS showed no evidence of an increase in investigator-reported serious cardiovascular adverse events in patients taking celecoxib. An interaction of colchicine with verapamil has also been described.