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Du nouveau sur les AINS: découverte de la COX-2 et implications pharmacologiques et cliniques

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Douleur et Analgésie

Résumé

Les AINS font partie des médicaments les plus utilisés, puisqu'ils représentent environ 5% de la prescription médicale, à laquelle s'ajoute une large utilisation sans ordonnance. Toutefois, leur usage clinique est restreint par les risques d'effets indésirables notamment au niveau digestif, des reins et des plaquettes. La mise en évidence récente de deux isoenzymes de la cyclooxygénase suggère que les effets indésirables des AINS seraient liés à l'inhibition de la COX-1, alors que la COX-2 inductible serait le lieu d'action désiré des AINS. Les AINS dits sélectifs pourraient représenter une innovation thérapeutique si la sécurité accrue qu'on en attend s'accompagne d'une efficacité comparable. Néanmoins, les produits actuellement disponibles, même les plus récents, ne peuvent prétendre à une meilleure tolérance au prix d'une même efficacité.

Summary

Non steroidal anti-inflammatory drugs (NSAIDs) account for some 5% of medical prescriptions to which must be added a large other-the-counter utilization. However, their clinical use is limited by the risk of side effects, particularly on the stomach, the kidney and the platelets. The recent discovery of the two isozymes of the cyclooxygenase allows to explain both the therapeutic effects (inhibition of COX-2) and side effects (inhibition of COX-1) of non steroidal antiinflammatory drugs. So-called selective NSAIDs could be a therapeutic innovation, provided that their expected better safety matches a comparable efficacy. Nevertheless, to date even the most recent available products cannot be credited for such advantages.

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Authors and Affiliations

  1. Centre multidisciplinaire d'évaluation et de traitement de la douleur, Hôpital Universitaire, Genève

    J. Desmeules & P. Dayer

  2. Division de Pharmacologie Clinique, Hôpitaux Universitaires de Genève, 24, rue Micheli-du-Crest, CH-1211, Genève 14

    S. Borel, P. Bonnabry, J. Desmeules & P. Dayer

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  1. S. Borel
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  2. P. Bonnabry
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  3. J. Desmeules
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Borel, S., Bonnabry, P., Desmeules, J. et al. Du nouveau sur les AINS: découverte de la COX-2 et implications pharmacologiques et cliniques. Doul. et Analg. 11, 71–75 (1998). https://doi.org/10.1007/BF03013286

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  • DOI: https://doi.org/10.1007/BF03013286

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