O glioblastoma multiforme (GBM) é um dos gliomas mais comuns, classificado como um glioma de grau IV (Organização Mundial da Saúde - OMS) e notoriamente difícil de ser tratado. O tratamento recomendado consiste na ressecção cirúrgica seguida de radio e quimioterapia, e a sobrevida média dos pacientes é de apenas 12 meses após o diagnóstico. Portanto, novas terapias que focam a redução do volume do tumor e o aumento da morte das células tumorais são urgentemente necessárias. Estudos pré-clínicos sugerem que a inibição de COX-1 e 2 com Anti-inflamatórios não esteroidais (AINEs), como o Ibuprofeno (IBP), inibiram significantemente a proliferação e a migração celular em diferentes tumores. Assim, o presente estudo teve como objetivo avaliar in vitro o efeito da inibição de COX-1 e COX-2 através do tratamento com IBP, e também com inibidores específicos como SC-560 e NS-398 respectivamente, na migração e na proliferação da linhagem celular de glioma humano U251-MG. O presente estudo demonstrou através de diversos ensaios que a inibição de COX-1 e COX-2 através do IBP, do SC-560 e do NS-398 inibiu significativamente a migração e a proliferação celular da linhagem celular U251-MG. Dessa maneira, concluímos que a PGE2 está envolvida na migração e proliferação celular das células desta linhagem celular. / Glioblastoma Multiforme (GBM) is the most common glioma, classified as grade IV (World Health Organization WHO) and notoriously difficult to treat. The recommended treatment consists of surgery followed by radiotherapy and chemotherapy, and the median survival is ten to twelve months. Preclinical studies suggest that inhibiton of cyclooxygenase-2 by treatment with non-steroidal anti-inflammatory drugs, such as ibuprofen, significantly blocked the proliferation of different tumors including gliomas. Thus this study aimed to evaluate the migration of glioma cell line U251-MG after inhibition of cyclooxygenases 1 and 2 by treatment with ibuprofen (IBP), and specifics inhibitors such as SC-560 for COX-1 and NS-398 for COX-2. The present study demonstrated by various assays where inhibition of COX-1 and COX-2 by IBP, SC-560 and NS-398, significantly inhibited migration and cell proliferation of U251-MG cell line. Thus, we conclude that PGE2 is involved in this cell line migration and cell proliferation.

Apesar do recente conhecimento do papel anti-inflamatório e anti-nociceptivo do H2S na artrite induzida por carragenina (CGN) em rato, os mecanismos envolvidos ainda não são conhecidos. Tampouco se sabe se compostos híbridos antiinflamatórios não esteroides (AINEs) doadores de H2S possuem vantagens farmacológicas adicionais quando comparados aos doadores de H2S clássicos. Apesar de H2S exercer um efeito anti-nociceptivo em modelos de inflamação e dor aguda, pouco se sabe sobre o papel deste gás na dor crônica. Neste estudo investigou-se os mecanismos do H2S no modelo de sinovite e participação desse gás na dor crônica. Verificou-se que os canais de K+ATP, canais de Ca2+ tipo L ou receptores TRPV1 não estão envolvidos no mecanismo protetor do H2S na sinovite, diminuição da IL-1b e aumento da IL-10 e não houve diferença em relação a participação das enzimas oxidantes GPx e GR. Ainda, o tratamento agudo com o doador de H2S não reverteu o desconforto do teste do Rota Rod e alodinia térmica. / Despite recent knowledge of the anti-inflammatory and anti-nociceptive role of H2S in the carrageenin-induced arthritis (CGN) in rats, the mechanisms involved are not yet known. Nor is it known whether hybrid compounds antiinflammatory drugs (NSAIDs) H2S donors have additional pharmacological advantages when compared to classical H2S donors. Although H2S exert an anti-nociceptive effect in models of inflammation and acute pain, little is known about the role of this gas in chronic pain . In this study we investigated the protective mechanisms of H2S in the model of synovitis and chronic pain . It was found that the K+ATP channel, L type Ca2+ channel or TRPV1 receptors are not involved in the protective mechanism of H2S in synovitis , decreased IL-1b and increased IL-10 and there was no difference in the participation of oxidant enzymes GPx and GR . Still, the acute treatment with H2S donor did not reverse the discomfort of the Rota Rod test and thermal allodynia.

Os antiinflamatórios não esteroidais (AINEs) constituem um grupo de medicamentos de uso rotineiro na terapêutica clínica, principalmente no tratamento do processo inflamatório e doloroso. O efeito colateral mais comum constatado pelo seu uso é a irritação da mucosa gástrica. A atividade ulcerogênica dos AINEs tem variabilidade diária, uma vez que quando administrados à noite, são melhor tolerados que durante o dia. Tal observação chama a atenção para a possível ação do hormônio pineal, melatonina, sintetizado no período de escuro, tanto por animais de hábitos noturnos como diurnos. No presente estudo foram investigados os efeitos da administração de melatonina sobre a atividade antiinflamatória e lesão gástrica induzida pelo piroxicam e o efeito da melatonina e do piroxicam sobre a síntese de PGE2 pela mucosa gástrica, testando esse hormônio nos seguintes modelos: edema de pata de rato induzido por carragenina, lesão da mucosa gástrica induzida pelo piroxicam e determinação da síntese de PGE2 por enzima-imunoensaio (EIA). A administração intragástrica de melatonina não alterou o efeito aniinflamatório do piroxicam, mas inibiu o efeito colateral ulcerogênico. O efeito antiulcerogênico da melatonina foi observado após administração intragástrica, mas não após a administração subcutânea. As diferenças observadas entre as duas vias de de administração sugere um efeito local desse hormônio sobre a mucosa gástrica. O efeito antiulcerogênico da mealtonina intragástrica esta relacionada à prevenção da inibição da produção der PGE2 da mucosa gástrica pelo piroxicam. A pinealectomia aumentou o efeito ulcerogênico da adminstração noturna de piroxicam. Mesmo utilizando fenilbutazona, que é um AINEs ulcerogenicamente mais potente, no período da manhã, quando o efeito ulcerogênico dos AINEs parece ser acentuado, a melatonina administrada intragastricamente promoveu proteção da mucosa gástrica. Por outro lado, a melatonina administrada intragastricamente não interferiu com ulceração induzida pelo estresse, sugerindo que o efeito antiulcerogênico da melatonina está relacionado mais especificamente com fatores importantes na patogênese da lesão gástrica induzida pelos AINEs (piroxicam e fenilbutazona) em ratos, prevenindo a inibição da síntese de PGE2 da mucosa gástrica induzida pelo piroxicam, sem afetar a ação antiinflamatória. / Non-steroidal antiinflammatory drugs are, the most frequently consumed drugs worlwide. They also cause gastrointestinal adverse effects, like gastric ulceration and bleedig. Several reports indicate that, both antiinflammatory effect and the susceptibility to mucosal damage produced by NSAIDs in rats and humans show a circadian variation. Nighttime administration of NSAIDs is better tolerated than morning administration in human and rats. Melatonin, the principal hormone of the pineal gland is secreted at night both in nocturnal and diurnal animals. The purpose of this experiment was to study the effect of melatonin on the antiinflammatory action and gastric mucosal damage induced by piroxicam and the effect of melatonin and piroxicam on the gastric mucosal prostaglandin E2 (PGE2) synthesis. Intragastric administration of melatonin significantly attenuated the gastric lesions induced by piroxicam, but, did not entiinflammatory action accessed by measuring paw edema after carrageenin adminstration. Melatonin anti-ulcerogenic effect was observed after intragastric, but not subcutaneus administration. The differences observed between the two administration routes point to a local effect of the hormone on the stomach mucosa. Pinealectomy increases the ulcerogenic effect of nocturnal administred piroxicam. The anti-ulcerogenic effect of intragastric melatonin was related to prevention of the inhibition of gastric mucosal PGE2 production induced by piroxicam. Indeed, intragastric administration of melatonin protect the gastric mucosa damage induced by effect on stress-induced gastric ulceration. These data suggest that melatonin may attenuate the severity of NSAID-induced gastric mucosal lesions in rats by preventing NSAID-induced inhibition of mucosal PGE2 production whithout affecting th anti-inflamamtory action.

Orientador: Juliany Gomes Quitzan / Resumo: O carcinoma de células escamosas (CCE) é uma neoplasia epitelial originada dos queratinócitos da pele de cães. Sua etiologia está relacionada à exposição a raios solares ultravioletas, o que o coloca como uma das neoplasias mais frequentes em países tropicais de clima quente. O CCE cutâneo tem comportamento invasivo local, baixa capacidade de metástase e frequentemente encontra-se associado à ceratose actinica. Neste estudo, objetivou-se avaliar o efeito do tratamento pré-operatório com piroxicam (Px) na expressão de COX-2 e Ki67, indicadores de inflamação e proliferação celular, respectivamente, em cães acometidos por CCE cutâneo. Além disso, o intervalo livre de doença (ILD) por um período de pelo menos 180 dias após excisão cirúrgica associada a regime de baixa dose diária com Px (0.3mg/kg) e ciclofosfamida (CYC; 15mg/m2) foi determinado nesta população. Não houve diferença estatística significativa na expressão de COX-2 após o tratamento pré-cirúrgico com Px; no entanto, houve diminuição no índice proliferativo marcado com Ki67 (P<0.05). Não foi encontrada alteração significativa no ILD no grupo tratado com Px e CYC (160 dias), quando comparado com o grupo controle retrospectivo (145 dias), tratado somente com ressecção cirúrgica. Não houve diferença estatística no ILD quando analisados o grau histológico, índice mitótico, tempo de evolução, metástase de linfonodos e o comprometimento das margens cirúrgicas. Adicionalmente, cães com estadiamento T4, independente do tratam... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Squamous cell carcinoma (SCC) is an epithelial neoplasm that arises from skin keratinocytes of the dogs. Its etiology is related to ultraviolet sunlight, which puts it as one of the most frequent neoplasm in tropical hot weather countries. Cutaneous SCC have a locally invasive, low metastatic behavior, and is often associated with actinic keratosis. This study aimed to evaluate the effect of pre-operative treatment with piroxicam (Px) on COX-2 and Ki67 expression, indicators of inflammation and cell proliferation, respectively. Besides that, the evaluation of disease-free interval (DFI) of these animals for at least 180 days after surgical excision associated with a daily low-dose treatment with Px (0.3mg/kg) and cyclophosphamide (CYC; 15mg/m2). There was no statically significant difference between COX-2 expression before and after treatment with Px; However, there was a significant decrease on Ki67 proliferative index (P<0.05). No significance was found in DFI when comparing the group treated with Px and CYC (160 days) and the control retrospective group (145 days), treated only with surgical resection. There was no statically difference on DFI when accessing histological grade, mitotic index, evolution time, lymph node metastasis, and incomplete surgical margins (P>0.05). Additionally, dogs with T4 stage, independent of the treatment, were 3.2 and 4.8-fold more likely to develop an early recurrence when comparing with T3 and T2, respectively. The results of this study demo... (Complete abstract click electronic access below) / Mestre

O glioblastoma multiforme (GBM) é um dos gliomas mais comuns, classificado como um glioma de grau IV (Organização Mundial da Saúde - OMS) e notoriamente difícil de ser tratado. O tratamento recomendado consiste na ressecção cirúrgica seguida de radio e quimioterapia, e a sobrevida média dos pacientes é de apenas 12 meses após o diagnóstico. Portanto, novas terapias que focam a redução do volume do tumor e o aumento da morte das células tumorais são urgentemente necessárias. Estudos pré-clínicos sugerem que a inibição de COX-1 e 2 com Anti-inflamatórios não esteroidais (AINEs), como o Ibuprofeno (IBP), inibiram significantemente a proliferação e a migração celular em diferentes tumores. Assim, o presente estudo teve como objetivo avaliar in vitro o efeito da inibição de COX-1 e COX-2 através do tratamento com IBP, e também com inibidores específicos como SC-560 e NS-398 respectivamente, na migração e na proliferação da linhagem celular de glioma humano U251-MG. O presente estudo demonstrou através de diversos ensaios que a inibição de COX-1 e COX-2 através do IBP, do SC-560 e do NS-398 inibiu significativamente a migração e a proliferação celular da linhagem celular U251-MG. Dessa maneira, concluímos que a PGE2 está envolvida na migração e proliferação celular das células desta linhagem celular. / Glioblastoma Multiforme (GBM) is the most common glioma, classified as grade IV (World Health Organization WHO) and notoriously difficult to treat. The recommended treatment consists of surgery followed by radiotherapy and chemotherapy, and the median survival is ten to twelve months. Preclinical studies suggest that inhibiton of cyclooxygenase-2 by treatment with non-steroidal anti-inflammatory drugs, such as ibuprofen, significantly blocked the proliferation of different tumors including gliomas. Thus this study aimed to evaluate the migration of glioma cell line U251-MG after inhibition of cyclooxygenases 1 and 2 by treatment with ibuprofen (IBP), and specifics inhibitors such as SC-560 for COX-1 and NS-398 for COX-2. The present study demonstrated by various assays where inhibition of COX-1 and COX-2 by IBP, SC-560 and NS-398, significantly inhibited migration and cell proliferation of U251-MG cell line. Thus, we conclude that PGE2 is involved in this cell line migration and cell proliferation.

Les analgésiques tel que le paracétamol, ou acétaminophène (ACE), et les anti-inflammatoires non stéroïdiens (AINS) comme l’aspirine et l’ibuprofène, sont largement utilisés dans le monde pour soulager douleur, fièvre ou inflammation. Ces médicaments, vendus sans ordonnance et souvent pris en automédication, sont de plus en plus utilisés par les femmes enceintes depuis les années 1990, notamment aux États-Unis et en Europe. De nombreuses études de cohorte ont mis en avant l’association entre la prise de ces molécules par les femmes durant le premier et deuxième trimestre de grossesse, et l’apparition de malformations congénitales des organes reproducteurs des garçons nouveau-nés, comme la cryptorchidie ou l’hypospadias. Ces analgésiques inhibent l’activité enzymatique des cyclooxygénases (Cox), qui catalysent l’étape clef de la voie de biosynthèse des prostaglandines (PGs), dont la prostaglandine D2 (PGD2), impliquée dans la détermination sexuelle des lignées somatique et germinale de la gonade mâle chez la souris. Afin d’étudier si la gonade embryonnaire peut constituer une cible de ces molécules, l’objectif principal de cette thèse a été d’analyser l’impact de l’exposition in utero à l’ACE, l’aspirine et l’ibuprofène seuls ou en combinaison, pendant la période de détermination sexuelle (de 10,5 à 13,5 jours post coitum (jpc) chez la souris). Des doses « thérapeutiques » similaires à celles utilisées chez l’Homme ont été administrées par voie orale. Mon travail a permis de démontrer que l’exposition in utero à la combinaison des deux drogues ACE et ibuprofène induisait, dans le testicule embryonnaire, une accélération de la différenciation de la lignée germinale du testicule embryonnaire, précurseurs des gamètes à l’âge adulte, par le biais d’une reprogrammation épigénétique avancée, ainsi qu’une augmentation du stockage du glycogène dans les cordons testiculaires, via l’activation de l’expression des gènes de la matrice extracellulaire. De plus, ce projet a permis d’identifier pour la première fois le profil d’expression des prostaglandines dans le testicule embryonnaire de souris. Dans un deuxième temps, l’impact de l’exposition in utero à ces drogues sur la stéroïdogenèse a été étudié, en parallèle avec l’étude sur le rôle de la PGD2 dans les cellules stéroïdogènes (cellules de Leydig) dans le testicule fœtal de souris à 17,5 jpc. Ces résultats pourraient conduire à modifier l’utilisation de ces médicaments chez la femme, au cours des deux premiers trimestres de grossesse. / Mild analgesics such as paracetamol, or acetaminophen (ACE), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, are widely used worldwide for relieving pain, fever or inflammation. These over-the-counter drugs are often taken as self-medication, and are increasingly used by pregnant women since the 1990s, particularly in the United States and Europe. Many cohort studies have highlighted the association between intake of these molecules by women during the first and second trimester of pregnancy, and the occurrence of birth defects of the reproductive organs of newborn boys, such as cryptorchidism or hypospadias. These analgesics inhibit the enzymatic activity of cyclooxygenases (Cox), which catalyze key step in the biosynthetic pathway of prostaglandins (PGs), whose prostaglandin D2 (PGD2), involved in the male sex determination of both somatic and germinal lineages in mice. To investigate whether the embryonic gonad can be a target of these molecules, the main objective of this thesis was to analyze the impact of in utero exposure to ACE, aspirin and ibuprofen alone or in combination, during the period of sex determination (10.5 to 13.5 days post coitum (dpc) in mice). "Therapeutic" doses similar to those used in humans were orally administered. My work has shown that in utero exposure to the combination of both ACE and ibuprofen drugs induced acceleration of the differentiation of the embryonic testis germline, the precursors of gametes in adulthood, through an advanced epigenetic reprogramming, and an increase of glycogen storage in the testicular cords, via activation of extracellular matrix gene expression. In addition, this project has identified for the first time the profile of prostaglandins expression in mouse embryonic testis. Secondly, the impact of in utero exposure to these drugs on steroidogenesis was evaluated, in parallel with the study on the role of PGD2 in steroidogenic cells (Leydig cells) in mouse fetal 17.5 dpc testis. These results could lead to change the use of these drugs in women, during the first two trimesters of pregnancy.

Growth of Staphylococcus aureus with the NSAID salicylate increases phenotypic resistance (SAPAR), and the frequency at which heritable resistance occurs to various antibiotics (SAGAR). This study describes the effect of salicylate on heritable and phenotypic resistance to a set of antibiotics for laboratory and multi-drug resistant strains of S. aureus and investigates the link between resistance and SAGAR. Drug gradient plates were used to determine phenotypic resistance to antibiotics targeting DNA replication, transcription, translation and the cell wall in the presence or absence of salicylate. To measure heritable resistance, mutation frequencies were determined for each antibiotic in the presence and absence of salicylate. Salicylate significantly increased mutation frequency of SH1000 to ciprofloxacin 27- fold from 4.9 x 10-8 to 8.5 x 10-7. A significant 8.5- fold increase was observed for LAC from 5.2 x 10-7 to 2.1 x 10-6. Conversely, salicylate significantly decreased mutation frequency for SH1000 to lincomycin 0.035-fold from 3.4 x 10-7 to 1.3 x 10-7. Deletion of the general stress sigma factor sigB encoding σB in SH1000 resulted in decreased heritable and phenotypic resistance, signifying the importance of σB in the full expression of both phenotypes. Metabolite profiling revealed downregulation of glycolysis, TCA, pentose phosphate pathway, and amino acid metabolism. The downregulation of the TCA cycle was confirmed as observed through an increase in NAD+ at growth toxic concentrations of salicylate. Salicylate has been shown to result in ROS accumulation and disruption of proton motive force in mitochondria. SAGAR was only detected for fluoroquinolones, which have been shown to impair TCA cycle and result in ROS accumulation. Examination of ROS under growth-toxic concentrations of salicylate did not reveal a significant increase in ROS levels. Also, the combination of ciprofloxacin and salicylate did not result in an increase in ROS levels. Despite this, addition of the antioxidant glutathione abrogated SAGAR for ciprofloxacin in SH1000 but not for SAPAR. Analysis of SAGAR with NSAIDs benzoate and acetyl salicylic acid revealed a necessity for the ortho hydroxyl group on salicylate to fully express SAGAR. These results suggest that salicylate has pleiotropic effects on S. aureus that include antimicrobial resistance, altered metabolic flux and accumulation of ROS as well as unidentified regulatory genes.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications globally. There are generally two types: selective (COX-2) and traditional NSAIDs (COX-1). They are primarily used for the treatment of pain. They gained attention after a study about their basic mechanisms highlighted their toxicity. Several studies have reported an association between NSAIDs and risk of myocardial infarction (MI). However, the direction of the relationship is not conclusive. Further studies are needed to ascertain the direction of this relationship and evaluate the present situation with available drugs. Due to the seriousness of cardiovascular diseases as one of the leading cause of death, continuous monitoring of the NSAIDs-MI association is needed. The purpose of this dissertation was to investigate the association between NSAIDs and MI in a younger (30-64 years) Kentucky Medicaid population with a 12 year window of data. The three specific aims were: (1) to understand the characteristics of the Kentucky Medicaid population with respect to NSAID use: (2) to evaluate the NSAID-MI relationship with a 12 year follow-up in a young heavily-burdened population for cardiovascular diseases: and (3) to investigate the MI risk of meloxicam, celecoxib and naproxen compared to no exposure. A retrospective study was conducted employing data from January 1st 2000 and December 31st 2012. The data comprised demographic, prescription and medical files. Within this cohort, a nested case control study was conducted. Cases of MI were matched to four controls on race and gender. The results suggested that exposure to COX 2 presented an increased adjusted risk for MI (1.138(0.983, 1.318)). However, this risk was significantly increased for COX-2 only users compared to COX-1 only users (1.221 (1.03, 1.485)) and 30-40 year olds (1.600 (1.082, 2.367)). Meloxicam, celecoxib and naproxen compared to no exposure showed meloxicam presented a non-significant different risk for MI (1.26 (0.98, 1.63)) and celecoxib presented a significantly increased risk for MI (1.52 (1.26, 1.82)). This study considered pattern of use in determining continuous usage by looking at both continuous and sporadic users of NSAIDs and also considered patient switching patterns between classes of NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for systemic control of acute and chronic pain and inflammation (Lin et ah, 2000:1129), but usage problems and side-effects that occur during the post-marketing phase of these drugs are well documented (Thiefin & Beaugerie, 2005:287). Following the demonstration of the value of anti-inflammatory therapy in diseases like rheumatoid arthritis (Boardman & Dudley Hart, 1967:268), new NSAIDs appeared on the market (Dieppe et al., 2004:867), and the indications steadily broadened from inflammatory diseases to almost any painful condition. Studies have indicated that NSAID-associated serious upper gastro-intestinal (GI) adverse events result in 103 000 hospitalisations (Bombardier, 2002:4) and 165 000 deaths per year in the United States. A study in South Africa in 2002 indicated that NSAID utilisation contributed considerably to the total cost of all medicine items from a medicine claim database in the private health care sector (Joubert, 2002:260). The objective of this study was to determine the prevalence and cost of non-steroid anti-inflammatory drugs in a section of the private health care sector, and specifically to determine the prevalence, usage and cost of Coxib (Specific cyclo-oxygenase-2 inhibitor) medicine items before and after the withdrawal of Vioxx® from the market in September 2004 (Merck, 2004). Data from two medicine claim databases for the years 2004, 2005 and 2006 (medicine claim database I) and the years 2005 and 2006 (medicine claim database M), were analysed by means of a retrospective drug utilisation review (DUR) study. The usage of Coxib medicine items was determined, and compared for the periods before and after the withdrawal of Vioxx® in September 2004. It was found that between 9 and 10.5 per cent of prescriptions dispensed through both medicine claim database I and medicine claim database M during the study period were NSAID prescriptions. NSAID medicine items on medicine claim database I represented between 3.9 % (R25 942 986) and 2.9 % (R8 073 034) of the total cost of all medicine items claimed from 2004 to 2006. NSAIDs represented 3.1 % (R58 290 412) and 2.8 % (R57 752 267) of the cost of all medicine items claimed through medicine claim database M during 2005 and 2006 respectively, indicating similar trends in the two medicine claim databases. The prevalence of Coxibs on medicine claim database I decreased from almost 20 % (47 938) in 2004 to 8.4 % (13 276) in 2005, but showed an increase again to 10.9 % (12 355) in 2006. The prevalence of both cyclo-oxygenase (COX) inhibitors, and Coxibs demonstrated a change during 1 September 2004 to 31 December 2004 when COX-inhibitors showed an increase in use, while Coxibs showed and almost equal but opposite trend with a decrease in use. This could possibly be related to perceptions of providers and public with regard to Coxibs and their related safety after the withdrawal of Vioxx® on 30 September 2004 (Merck, 2004) and other Coxibs such as Bextra® (FDA, 2005) in 2005 in USA. It is concluded that most patients who were using Coxibs before the withdrawal of Vioxx®, substituted Coxibs for COX-inhibitors, that are known for their possible gastro-intestinal side-effects. Recommendations for future research regarding NSAID use were also made, and included an investigation of the usage of Coxibs in different age groups, as well as the combination of NSAIDs with gastro-protective medicines in long-term use. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for systemic control of acute and chronic pain and inflammation (Lin et ah, 2000:1129), but usage problems and side-effects that occur during the post-marketing phase of these drugs are well documented (Thiefin & Beaugerie, 2005:287). Following the demonstration of the value of anti-inflammatory therapy in diseases like rheumatoid arthritis (Boardman & Dudley Hart, 1967:268), new NSAIDs appeared on the market (Dieppe et al., 2004:867), and the indications steadily broadened from inflammatory diseases to almost any painful condition. Studies have indicated that NSAID-associated serious upper gastro-intestinal (GI) adverse events result in 103 000 hospitalisations (Bombardier, 2002:4) and 165 000 deaths per year in the United States. A study in South Africa in 2002 indicated that NSAID utilisation contributed considerably to the total cost of all medicine items from a medicine claim database in the private health care sector (Joubert, 2002:260). The objective of this study was to determine the prevalence and cost of non-steroid anti-inflammatory drugs in a section of the private health care sector, and specifically to determine the prevalence, usage and cost of Coxib (Specific cyclo-oxygenase-2 inhibitor) medicine items before and after the withdrawal of Vioxx® from the market in September 2004 (Merck, 2004). Data from two medicine claim databases for the years 2004, 2005 and 2006 (medicine claim database I) and the years 2005 and 2006 (medicine claim database M), were analysed by means of a retrospective drug utilisation review (DUR) study. The usage of Coxib medicine items was determined, and compared for the periods before and after the withdrawal of Vioxx® in September 2004. It was found that between 9 and 10.5 per cent of prescriptions dispensed through both medicine claim database I and medicine claim database M during the study period were NSAID prescriptions. NSAID medicine items on medicine claim database I represented between 3.9 % (R25 942 986) and 2.9 % (R8 073 034) of the total cost of all medicine items claimed from 2004 to 2006. NSAIDs represented 3.1 % (R58 290 412) and 2.8 % (R57 752 267) of the cost of all medicine items claimed through medicine claim database M during 2005 and 2006 respectively, indicating similar trends in the two medicine claim databases. The prevalence of Coxibs on medicine claim database I decreased from almost 20 % (47 938) in 2004 to 8.4 % (13 276) in 2005, but showed an increase again to 10.9 % (12 355) in 2006. The prevalence of both cyclo-oxygenase (COX) inhibitors, and Coxibs demonstrated a change during 1 September 2004 to 31 December 2004 when COX-inhibitors showed an increase in use, while Coxibs showed and almost equal but opposite trend with a decrease in use. This could possibly be related to perceptions of providers and public with regard to Coxibs and their related safety after the withdrawal of Vioxx® on 30 September 2004 (Merck, 2004) and other Coxibs such as Bextra® (FDA, 2005) in 2005 in USA. It is concluded that most patients who were using Coxibs before the withdrawal of Vioxx®, substituted Coxibs for COX-inhibitors, that are known for their possible gastro-intestinal side-effects. Recommendations for future research regarding NSAID use were also made, and included an investigation of the usage of Coxibs in different age groups, as well as the combination of NSAIDs with gastro-protective medicines in long-term use. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.