Celebrex (celecoxib) is an anti-inflammatory therapy marketed by Pfizer that can help manage such common symptoms of scleroderma as arthritis-like joint pain.
How Celebrex works
Scleroderma is an autoimmune disease marked by an overactive immune system that mistakenly targets healthy tissues. This causes a range of problems, including chronic inflammation. Injury to the joints results in arthritis-like swelling, stiffness, and pain, and can lead to permanent damage.
Celebrex is a type of non-steroidal anti-inflammatory drug (NSAID). Unlike other NSAIDs, it works by specifically blocking an enzyme called cyclooxygenase-2 (COX-2) and is therefore classed as a COX-2 inhibitor.
COX-2 is involved in triggering inflammation. As part of the immune response, it facilitates the production of prostaglandins that stimulate inflammation at sites of infection or damage.
By blocking prostaglandin production, Celebrex reduces inflammation and the pain that typically accompanies it.
Other NSAIDs, such as ibuprofen and naproxen, are less specific in their effects because they also block a similar enzyme, COX-1, along with COX-2. COX-1 plays an important role in the stomach, so blocking it can increase gastrointestinal side effects like diarrhea. (COX-2 inhibitors, however, aren’t devoid of such side effects.)
Celebrex in clinical trials
Celebrex has not been specifically tested for scleroderma, but its safety and efficacy have been studied in many clinical trials for conditions such as arthritis.
A randomized trial compared Celebrex with naproxen and with placebo in 1,149 arthritis patients in the U.S and Canada. The results, published in JAMA Network in 1999, demonstrated that Celebrex significantly improved symptoms compared to the placebo, with similar levels of effectiveness to naproxen.
A randomized, placebo-controlled, and double-blind clinical trial, called CLASS, investigated the safety of Celebrex compared to conventional NSAIDs in 8,059 patients in the U.S and Canada. Its results, also published in JAMA Network, confirmed significantly fewer gastrointestinal side effects in patients treated with Celebrex compared to other NSAIDs.
Another clinical trial, a Phase 4 study (NCT00346216) called PRECISION, compared the safety of Celebrex to ibuprofen and naproxen in 2,4081 arthritis patients worldwide. Results, published in the New England Journal of Medicine, confirmed that Celebrex did not increase the risk of cardiovascular problems. This trial was undertaken to relieve safety concerns after Vioxx (rofecoxib), another COX-2 inhibitor, was recalled in 2004 due to a greater risk of cardiovascular disease — including heart attack and stroke — among users.
Other information
Common side effects of Celebrex include flu-like symptoms, swelling, and rashes. Other symptoms can include gastrointestinal problems such as diarrhea and stomach pain.
Celebrex may reduce the effectiveness of ACE inhibitors, a common therapy for kidney involvement in scleroderma. Patients are advised to consult with a doctor before starting this therapy.
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