Nonselective inhibition of cyclooxygenase by nonsteroidal anti-inflammatory drugs frequently induces renal failure in decompensated cirrhosis.
Studies in experimental cirrhosis suggest that selective inhibitors of the inducible isoform cyclooxygenase-2 do not adversely affect renal function.
However, very limited information is available on the effects of these compounds on renal function in human cirrhosis.
Dr Arroyo and colleagues conducted a double-blind, randomized, placebo-controlled trial.
The researchers compared the effects of the selective cyclooxygenase-2 inhibitor celecoxib (200 mg every 12 hours for a total of 5 doses)on platelet and renal function and the renal response to furosemide (40 mg intravenously).
Naproxen in patients reduced glomerular filtration rate and inhibited platelet aggregation|
The team compared these effects with those of naproxen (500 mg every 12 hours for a total of 5 doses)and placebo.
The research team included 28 patients with cirrhosis and ascites.
The investigators found a significant reduction in glomerular filtration rate (113 to 84 mL/min)and renal plasma flow (592 to 429 mL/min) in the patients treated with naproxen.
There were also no significant reductions found in urinary prostaglandin E2 excretion (3,430 to 2,068 pg/min) and suppression of the diuretic (urine volume: 561 to 414 mL/h) in those patients.
The researchers observed natriuretic (urine sodium: 53 to 34 mEq/h) responses to furosemide in the group of patients treated with naproxen but not in the other two groups.
The team reported that naproxen, but not celecoxib or placebo, significantly inhibited platelet aggregation (72% to 47%) and thromboxane B2 production (41 to 14 pg/mL).
Dr Arroyo concludes, “Our results indicate that short-term administration of celecoxib does not impair platelet and renal function and the response to diuretics in decompensated cirrhosis.”
”Further studies are needed to evaluate the long-term safety of this drug in cirrhosis.”