FEARFUL side-effects that have prohibited the appearance of certain anti-inflammatory arthritis drugs in our pharmacies could soon become irrelevant, after researchers uncover a potential test to identify just who should avoid COX-2 inhibitors.
COX-2 inhibitors, a type of non-steroidal anti-inflammatory drug (NSAID), are widely used for providing pain relief to patients suffering debilitating inflammatory conditions, such as arthritis. Yet, while they alleviate pain, the drugs can also increase some individuals’ risk of heart attack; the question of how this occurs has been the subject of research for a decade.
Now a new study using both mice models and human volunteers may be able to explain this phenomenon; researchers have explored how removing COX-2 causes disruption in murine gene activity. “If we could identify which people have an increased risk [of heart attack], these patients could be offered more appropriate treatments – and we can start to look at ways of reducing or averting the risk entirely,” said Prof Jane Mitchell, Professor of Pharmacology in Critical Care Medicine, Head of Vascular Biology, the National Heart and Lung Institute, Imperial College London, London, UK.
NSAIDS are designed to prevent the production of prostaglandins, which, produced by the enzymes COX1 and COX2, trigger pain and inflammation at sites around the body. Researchers found that knocking out COX-2 caused changes in 3 genes in the kidney which predicted a rise in levels of ADMA, a molecule linked to cardiovascular disease; in subsequent tests, NSAIDS led to a rise in ADMA levels in 16 human subjects.
Prof Mitchell believes that these ADMA levels may be a reliable indicator of those patients who are at greater risk of a heart attack: “If we are right,” said Prof Mitchell, “ADMA could be used as a biomarker in a simple blood test to identify who may be at risk, and regular screening would allow GPs to monitor patients’ ADMA levels to ensure these remain within safe limits whilst taking the drug.”
The research team plan to test their ideas in clinical trials in the near future.