COX-2 Drugs: And then there was one

How much longer can the COX-2 painkillers survive?  There’s just one version left on the market – Pfizer’s Celebrex (celecoxib) – and that has been found to dramatically increase the risk of heart attack among cancer patients in a new study published last week.

Industry pundits reckon it will soon go the way of Bextra (valdecoxib), which was withdrawn in 2005, and the notorious Vioxx (rofecoxib), which was voluntarily withdrawn by the manufacturer ahead of the costliest class action suit in American legal history.

Celebrex is still being regularly used to ease arthritis and period pain – and it also slows the progress of bowel cancer.  But when it was taken by a group of patients, the drug increased the risk of serious heart problems by more than three times, posing an unacceptable risk, researchers said.

Another study of Celebrex among cancer patients came up with a similar result a year ago.

Patients at highest risk were those taking the 400 mg daily dose, but even patients on half that dose still more than doubled their chances of developing heart problems.

This seems to be a familiar pattern.  Vioxx was withdrawn in 2004 because it was suspected of causing heart attack and stroke, and recent studies have found that the effect can happen even very shortly after starting the drug.  
Bextra, which is also manufactured by Pfizer, was withdrawn on the instructions of drug regulators because of similar concerns.  Merck, Vioxx’s manufacturer, has been paying millions of dollars to families of patients who died from a heart attack while taking the drug, and it’s reckoned damages could reach into the billions.

The COX-2s were designed to be a kinder and gentler version of the traditional NSAID (non-steroidal, anti-inflammatory drugs) painkillers.  They were supposed to be just as effective, while overcoming the problems of the NSAIDs, which can cause ulcers and other stomach problems.

But one study that compared the two painkillers in a large group of arthritis sufferers found that, after four years’ usage, just as many patients were getting ulcers while on a COX-2 as those taking a traditional NSAID.
That’s if they didn’t die from a heart attack in the meantime, presumably.

(Source: New England Journal of Medicine, 2006; 355: 873-84).


E-news broadcast 7 September 2006 No.290 [Subscribe]