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Andrew Whelton, MD; Gerald Schulman, MD; Carl Wallemark, MS; Edward J. Drower, MS; Peter C. Isakson, PhD; Kenneth M. Verburg, PhD; G. Steven Geis, PhD, MD

Arch Intern Med. 2000;160:1465-1470.

Objective  To compare the effects of celecoxib, a cyclooxygenase 2–specific inhibitor, with the nonspecific cyclooxygenase 1 and 2 inhibitor naproxen on renal function in 29 healthy elderly subjects in a single-blind, randomized, crossover study.

Methods  Subjects received either celecoxib, 200 mg twice daily, for 5 days followed by celecoxib, 400 mg twice daily, for the next 5 days, or they received naproxen, 500 mg twice daily, for 10 days. After a 7-day washout, subjects were crossed over to receive the other regimen.

Results  After the first dose, the trend was for a greater decrease in glomerular filtration rate with naproxen (-5.31 mL/min per 1.73 m²) compared with celecoxib (-0.86 mL/min per 1.73 m²). The treatment difference became statistically significant on day 6 (-7.53 vs -1.11 mL/min per 1.73 m² for naproxen and celecoxib, respectively; P=.004). Urinary prostaglandin E₂ and 6-keto-prostaglandin F₁ excretion was significantly reduced from baseline across the treatment interval with both celecoxib and naproxen (P.04). There were no significant differences in prostaglandin excretion between these 2 agents (P.07). Small, transient decreases (P<.05) in urinary sodium excretion were observed after the initiation of both celecoxib and naproxen treatment. Sodium excretion values returned to baseline by the end of the study.

Conclusions  The results indicate that cyclooxygenase 2–specific inhibition in healthy elderly subjects may spare renal hemodynamic function, although the effects on sodium excretion, as well as urinary prostaglandin E₂ and 6-keto-prostaglandin F₁ excretion, appear to be similar to those of nonspecific cyclooxygenase inhibitors such as naproxen.

From the Universal Clinical Research Center, Inc, and the Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Whelton); Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn (Dr Schulman); and Searle Research and Development, Skokie, Ill (Messrs Wallemark and Drower and Drs Isakson, Verburg, and Geis).

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