Abstract TP119: Celecoxib In Aneurysmal Subarachnoid Hemorrhage: A Single Center Experience

Abstract

Introduction: Inflammation may play a central role in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Prostaglandins are inflammatory mediators that are elevated in aSAH and are synthesized by cyclooxygenase-2 (Cox-2). Celecoxib is a selective Cox-2 inhibitor with anti-inflammatory effects and good central nervous system penetration. In a mouse model of SAH, Cox-2 gene expression was found to be up-regulated in brain endothelial cells and celecoxib was found to limit Cox-2 up-regulation. We sought to evaluate the safety of celecoxib in patients with aSAH for future clinical studies. Methods: We used a matched case-control study to evaluate safety of celecoxib in aSAH patients. Our prospectively collected aSAH database (N=230) was retrospectively reviewed from 1/2010 - 2/2020. Celecoxib cases (N=13) and controls (N=217) were matched by closest Euclidean distance based on age and Glasgow Coma Scale (Figure 1). Each case was matched with 4 controls to maximize power based on closest Euclidean distance. Baseline characteristics for cases and controls were compared using a t-test or signed rank test for pairs. Categorical variables were compared using McNemar’s test for discordant pairs. A p value ≤.05 was considered significant for all univariate testing. Results are listed in Table 1. Discussion: No adverse events were associated with celecoxib use. At our center, celecoxib was primarily used in high grade aSAH for fever or headache. Maximum and mean temperature are statistically higher in the celecoxib group, consistent with the treatment indication. There were no differences in vasospasm prevalence, although our analysis is limited by sample size. Given the favorable safety profile, ease of drug availability, and plausible mechanism of therapeutic effect, celecoxib warrants further study in aSAH.