To review clinical evidence on short-term selective COX-2 inhibitor use in IBD, focusing on disease activity outcomes and intestinal safety.
Approach:
Literature Search: A prespecified literature search was performed in PubMed and the Cochrane Library, supplemented by reference list screening, to identify clinical trials and studies evaluating celecoxib, etoricoxib, or rofecoxib in IBD patients with musculoskeletal symptoms.
Key Findings:
Two placebo-controlled randomized trials showed no higher rates of IBD relapse or symptom aggravation compared to placebo during short-term treatment.
Open-label studies and retrospective series reported variable gastrointestinal adverse events and occasional symptom worsening.
The strongest evidence supports cautious short-term use of selective COX-2 inhibitors in selected patients with IBD in remission.
Interpretation:
Given the small evidence base and limited follow-up, treatment should be time-limited, use the lowest effective dose, and include clinical monitoring.
Limitations:
Study populations, baseline disease activity, relapse definitions, and follow-up duration varied widely across studies.
The evidence base is small and lacks extensive follow-up.
Conclusion:
Cautious short-term use of selective COX-2 inhibitors may be appropriate for managing musculoskeletal pain in IBD patients in remission.
