To counter problems of stomach upsets with the NSAIDs, drug companies have devised two new drug families-the nonacetylated salicylates, and COX-2 (cyclo-oxygenase-2) inhibitors. The latter is designed to stop the release of cyclo-oxygenase 2, a chemical in the body that can cause inflammation.
While both are supposed to be kinder to the stomach, neither offers the protection to the heart that NSAIDs can. So arthritis sufferers who cannot tolerate a traditional NSAID may need to supplement their drug therapy with other heart medication, especially if they already have heart disease or have some of the risk factors.
So if COX-2 patients end up taking an aspirin for their heart, they might as well stick to an NSAID in the first place.
Two of the first to be marketed-Celebrex (celecoxib) and Vioxx (rofecoxib)-quickly became the most successful drugs in medical history, outstripping the demand even for Viagra.
Celebrex suffered a dramatic, but short-lived, dip in sales after 10 people who were taking the drug suddenly died. However, a causal link between the deaths and the drug was never established. And Vioxx has been voluntarily removed from the international market after a possible association to heart problems, even resulting in death. A recent study revealed that the drug could cause an increased risk of heart attack and stroke if taken over a long period.
This association is currently being tested in a series of test cases throughout the United States. If the cases are proven against the manufacturer, the settlements could be the highest in commercial history.
Marketing trials suggest that the COX-2s can also cause ulcers and the other gastrointestinal problems usually identified with a standard NSAID, even though one of their main claims to fame was fewer stomach upsets.