Association of COX-2 Selectivity in Pain Medication Use with Endometriosis Incidence: Retrospective Cohort Study

• Published in: Yonsei medical journal Vol. 66; no. 6; pp. 374 - 382
• Main Authors: Park, Jongchan, Chang, Hye Jin, Hwang, Kyung Joo, Yum, Sun Hyung, Park, Chang Eun, Kim, Joo Hee, Kim, Miran
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.06.2025; 연세대학교의과대학
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Cyclooxygenase 2 - metabolism; Cyclooxygenase 2 Inhibitors - therapeutic use; Endometriosis - drug therapy; Endometriosis - epidemiology; Female; Humans; Incidence; Middle Aged; Original; Pain - drug therapy; Proportional Hazards Models; Retrospective Studies; Young Adult; 의학일반; Endometriosis; Celecoxib; Cohort Study; COX-2; OMOP-CDM; Ibuprofen
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2024.0255

This retrospective cohort study aimed to investigate the association between the use of pain medications with varying cyclooxygenase-2 (COX-2) selectivity and the incidence of endometriosis (EMS) in women. Medical records from January 1, 1994, to December 31, 2022, were retrospectively analyzed. The cohort included 33406 patients diagnosed with any pain-related condition who were prescribed either selective COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs). Patients were followed for up to 5 years from the cohort entry date. The incidence of EMS was compared between the two medication groups using Cox proportional hazards models, adjusting for confounding factors such as age, past drug use, and prior diagnosis. The incidence rates of EMS were 3.00 per 1000 person-years in the COX-2 inhibitor group and 3.97 per 1000 person-years in the NSAIDs group. After adjustment for confounders, the hazard ratio for EMS incidence in the COX-2 inhibitor group compared to the NSAIDs group was 0.77 [95% confidence interval (CI), 0.63 to 0.93; <0.01], indicating a significantly lower risk in the COX-2 inhibitor group. Subgroup analysis revealed that this association was particularly significant in younger women aged 20-44 years, with a hazard ratio of 0.71 (95% CI, 0.54 to 0.95; <0.05) in this age group. The findings suggest that COX-2 inhibitors may reduce the incidence of EMS compared to traditional NSAIDs, highlighting their potential as a strategic option for managing EMS, particularly among younger women. Further prospective studies are needed to confirm these findings.