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The COX-2 difficulties

The molecular rationale for cyclo-oxygenase 2 inhibitors is simple: avoid gastrointestinal complications associated with traditional non-steroidal anti-inflammatory drugs by focusing on the specific COX-2 enzyme primarily found in inflamed tissues, not on the COX-1 enzymes found in a variety of tissues including those in the stomach.

But this rationale has yet to pan out fully in the real world. In part, the theory hasn't been fully tested, because some of the clinical trials had flaws - such as allowing concomitant use of aspirin, which can cause GI

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