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To the Editor: In his Clinical Crossroads article about a 57-year-old man with arthritis, Dr Lonner¹ stated that cyclooxygenase-2 (COX-2) selective inhibitors are as effective as nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), but may have "decreased toxicity on non-target tissues such as the gastric mucosa, although at 15 to 20 times the cost." In support of this assertion he cites data from the Celecoxib Long-term Arthritis Safety Study (CLASS).² In fact, however, a later analysis revealed that 12 months of celecoxib was no safer than other NSAIDs, and the US Food and Drug Administration disagreed with the manufacturer's claim that celecoxib was safer.³

Thomas E. Finucane, MD
Division of Geriatric Medicine and Gerontology
Johns Hopkins Geriatrics Center
Baltimore, Md

1. Lonner JH. A 57-year-old man with osteoarthritis of the knee. JAMA. 2003;289:1016-1025. FREE FULL TEXT 2. Silverstein FE, Faich G, Goldstein JL, et al, Celecoxib Long-term Arthritis Safety Study. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA. 2000;284:1247-1255. FREE FULL TEXT 3. Witter J. Celebrex Capsules (Celecoxib): Medical Officer Review. Available at: http://www.fda.gov/ohrms/dockets/ac/01/briefing/3677b1_03_med.pdf. Accessed June 16, 2003.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:36.

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