Three recent developments with respect to therapy with non-steroidal anti-inflammatory drugs (NSAIDs) are the identification of two isoenzymes of cyclooxygenase (COX-1 and COX-2), the development of NO-NSAIDs, and the availability of low-dose over-the-counter (OTC) NSAIDs.
COX-1 products mainly have a physiologically regulating and protective effect, while COX-2 products result in inflammation.
There is initial enthousiasm for selective COX-2 antagonists with respect to the gastrointestinal adverse reactions. However, recent animal data indicate that high doses of COX-2 antagonists are usually necessary to obtain an adequate anti-inflammatory effect, which doses also antagonize COX-1.
The development of NO-NSAIDs is also promising. These drugs release NO which may protect the local microvasculature. However, there is as yet hardly any practical experience with these drugs.
OTC use of low-dose NSAIDs is increasing. As far as is now known, the overall risk is low because of the lower dose used. Nevertheless, the usual contra-indications should be kept in mind, such as age over 60 years, a prior history of peptic ulcers, co-morbidity, and concurrent treatment with other NSAIDs or anticoagulants.