A narrative review examining the clinical safety and efficacy of polmacoxib: current evidence and upcoming prospects

Non-steroidal anti-inflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2) are indicated for managing pain across diverse conditions like osteoarthritis (OA), rheumatoid arthritis (RA), and migraines. Compared to non-selective NSAIDs, they offer reduced gastrointestinal toxicity, as evidenced in short-term trials. However, concerns about cardiovascular risks associated with traditional COX-2 inhibitors have driven the development of newer agents such as polmacoxib, which also targets carbonic anhydrase (CA) isoforms. Originally approved in South Korea in 2015 as CG100649, polmacoxib demonstrates dual inhibition of COX-2 and CA enzymes, suggesting potential advantages in efficacy and systemic safety over standard NSAIDs. Initial studies, primarily in OA and adhesive capsulitis among Asian population, indicate promising results, although comprehensive clinical data across various medical conditions are still emerging. Approval of polmacoxib for idiopathic primary OA in India highlights its emerging role as an innovative therapeutic option. The present narrative review focuses on the current knowledge of polmacoxib, addressing gaps in understanding its clinical safety and efficacy. By analyzing data from early trials and pharmacokinetic studies, the review explores dual mechanisms of polmacoxib and their implications for therapeutic practice. Continuing research is crucial to fully realize its potential in managing inflammatory pain disorders and to guide future pharmacotherapy strategies.