Celecoxib Decreases GCF Prostaglandin E2 Levels in Chronic Periodontitis Patients

Objectives: Prostaglandin E2 (PGE2) is a key mediator associated with periodontal bone loss. We recently demonstrated (Yen et al, J Periodontol 79:104, 2008) that adjunctive use of Celecoxib (a COX-2 selective inhibitor) in conjunction with scaling and root planning (SRP) resulted in significant reduction in pocket depth (PD) and gain in clinical attachment (CAL) in chronic periodontitis (CP) patients. The purpose of this study was to explore any association between PGE2 levels in the gingival crevicular fluid (GCF) and clinical periodontal signs in a subset of subjects who took part in a double-blind, placebo-controlled, randomized clinical trial investigating the effects of Celecoxib (COX-2 ) on CP.

Material and Methods: Sixty-four subjects were randomly selected from the total subject pool of 131. After a comprehensive periodontal examination, subjects were randomized to receive either 200mg Celecoxib (COX-2, n=35) or placebo (PLA, n=29) once/day for 6-months in conjunction with SRP. Probing depth (PD) and clinical attachment level (CAL) were recorded and GCF samples were collected from six different teeth (one site per tooth) at three time points (baseline, three months and six months).Concentrations of PGE2 in GCF samples were measured using enzyme-linked immunosorbent assay.

Results: PD and CAL improved significantly over the 6 month period. There was a modest positive relationship between PD and PGE2 (spearman rank correlation: r = 0.12, p=0.037).

The COX-2 group demonstrated a statistically significant decrease in PGE2 levels from baseline to 3 months compared to the placebo group (65.5 pg/ml vs. 13.5 pg/ml, p=0.013), but not at 6 months (109.8 pg/ml vs. 71.2 pg/ml, p=0.12).

Conclusions: These results suggest that Celecoxib (COX-2) in conjunction to SRP significantly reduces PGE2 levels in the GCF in the first 3 months post treatment in CP patients. This decrease is associated with improved clinical outcomes (investigator-initiated study funded by Pfizer).