Aspirin‐triggered lipoxin in patients treated with aspirin and selective vs. nonselective COX‐2 inhibitors

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Previous data have suggested that selective cyclooxygenase (COX)-2 inhibitors enhance aspirin-induced gastrotoxicity through the suppression of a protective lipoxygenase metabolite, called aspirin-triggered lipoxin (ATL). WHAT THIS STUDY ADDS • Neither the selective COX-2 inhibitor celecoxib nor the nonselective inhibitor ibuprofen appreciably interfered with ATL urinary excretion in a double-blind, placebo-controlled trial, suggesting that this mediator is not involved in the exacerbation of aspirin-induced gastrotoxicity by COX-2 inhibitors. AIMS Cyclooxygenase (COX)-2 inhibition has been reported to suppress the biosynthesis of the gastroprotective lipoxygenase metabolite 15(R)-epi-lipoxin A4, also termed ‘aspirin-triggered lipoxin’ (ATL). We tested the hypothesis that the co-administration of aspirin with either the selective COX-2 inhibitor celecoxib or the nonselective COX inhibitor ibuprofen reduces ATL biosynthesis. METHODS We measured the urinary excretion of ATL in 24 patients with both ischaemic heart disease and osteoarthritis, chronically treated with aspirin and co-administered celecoxib 200 mg b.i.d., ibuprofen 600 mg t.i.d., or placebo for 7 days. RESULTS Baseline ATL was comparable in the three groups. On days 1 and 7, 4 h after co-administration of celecoxib or ibuprofen, ATL levels did not show significant variations (day 1: 0.24 ± 0.33, 0.26 ± 0.21 and 0.37 ± 0.22 ng mg−1 creatinine, respectively; day 7: 0.21 ± 0.13, 0.35 ± 0.15 and 0.23 ± 0.18 ng mg−1 creatinine, respectively). CONCLUSIONS Neither selective nor nonselective COX-2 inhibition appreciably interferes with ATL biosynthesis, suggesting that this mediator is not involved in exacerbating gastrotoxicity by the association of aspirin with COX-2 inhibitors.