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V. P. Shah, M. Pham, V. Gullapalli, D. S. Chu; Selective and Nonselective COX Inhibitors are Equally Effective in the Treatment of Non-Infectious Scleritis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2690.
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To compare the effectiveness of selective cyclooxygenase-2 inhibitors(COX2I) versus nonselective cyclooxygenase inhibitors(COXI) in the treatment of inflammation associated with scleritis and episcleritis.
We conducted a retrospective chart review of all patients treated for non-infectious scleritis and episcleritis between August 2001 and October 2008 at our institution. Inflammation was graded by a single physician prior to start of treatment and at each follow-up visit. Patients treated with either a COX2I (celecoxib or rofecoxib) or COXI (diclofenac, ibuprofen, or naproxen) were included in the study. Grading of scleritis at the final visit (minimum 10 weeks) was then compared with pre-treatment grade by repeated measures analysis of variance.
A total of 123 cases were reviewed. 60 patients were included in the study: 47 women and 13 men with a mean age of 49.7 years. 41 patients were documented to have scleritis and 19 episcleritis. Thirty-four patients were treated with COXI and 26 were treated with COX2I, some receiving both, sequentially. There was no statistical difference between patients receiving the two groups of drugs. Eighteen scleritis patients responded to a COX2I and 18 responded to a COXI. Five episcleritis patients responded to a COX2I and 12 responded to a COXI. Even though inflammation did improve with both types of Cox inhibitors, a subset of 6 patients required a switch from one group to the other. All of these patients were successfully controlled after the switch. Four switched from a COXI to a COX2I and 2 switched from a COX2I to a COXI. There were no serious adverse reactions or long-term morbidity caused by treatment. Three patients taking a COXI reported gastrointestinal symptoms. One of these patients discontinued therapy. One patient taking a COX2I reported a rash and another reported diarrhea and nausea. One of these patients discontinued therapy.
Cox inhibitors can be safely used to control inflammation associated with non-infectious scleritis or episcleritis. We found no statistically significant difference in toxicity between the 2 types of cyclooxygenase inhibitors. There is no medical benefit of using COX2I in the treatment unless there is a lack of response with non-selective inhibitors.
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