YOU AND A: ARTHRITIS DRUGS
Pain and Confusion
By Francesca Lunzer Kritz
Special to The Washington Post
Tuesday, September 4, 2001; Page HE01
An article in the Aug. 22/29 issue of the Journal of the American Medical Association (JAMA) suggested that popular arthritis drugs Vioxx and Celebrex may increase the risk of cardiovascular events -- including heart attacks, strokes and chest pain. The news could affect millions of arthritis patients who currently use the drugs.
Approved in 1999, Vioxx and Celebrex generally help relieve pain without the gastrointestinal symptoms -- such as stomach pain, bleeding and stomach ulcers -- sometimes associated with many other non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (such as Motrin and Advil).
Vioxx and Celebrex, which belong to a class of drugs called COX-2 inhibitors, hold more than 60 percent of the arthritis drug market and last year had combined sales of just over $4 billion. Vioxx was the nation's most heavily advertised prescription drug last year, according to IMS Health, a health information company; Celebrex ranked seventh in advertising.
Both Merck, which makes Vioxx, and Pharmacia, which makes Celebrex, dispute the findings reported in JAMA and insist their drugs are safe.
My doctor recently prescribed Vioxx for my arthritis. TV commercials make it look like a wonder drug. Should I ask for something else?
As you were about to guess, the answer is, "it depends" -- partly on your risk for heart problems otherwise, and partly on other factors. The researchers who wrote the JAMA article, heart specialists at the Cleveland Clinic, examined four previously published studies on the drugs to see how many study subjects suffered cardiovascular events, including a blood clot, heart attack or stroke. So this was not research conducted specifically for the purpose of exploring negative effects on the heart, but an examination of data collected for other purposes to see if they provided any information about these drugs and heart problems.
Oh, so I can ignore the studies?
Well, no. To some experts, they suggest reason for concern. One study showed twice as high a rate of cardiovascular events for people taking Vioxx as for those who took naproxen, another pain reliever. However, the absolute incidence was low: 1.3 percent for the Vioxx group versus 0.67 for those taking naproxen. What isn't clear is whether Vioxx increased risk by causing blood platelets to clump together and thereby promoting a clot, or whether naproxen protected some people from heart attacks by keeping platelets from clumping together.
That doesn't sound good. What about the other studies?
A second study compared Celebrex to two other drugs commonly prescribed for arthritis: ibuprofen and diclofenac (Cataflam and Voltaren). Researchers found more heart attacks in the Celebrex group than other groups, according to Eric Topol, the study's lead author and chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, although he said the difference was not statistically significant. However, some patients in this study also took aspirin, which can protect the heart from clots and heart attacks. The other two studies compared Vioxx with other arthritis drugs, and also included some aspirin-takers. Taken together, says Topol, the four trials consistently showed a small excess of cardiac events among the patients taking Vioxx or Celebrex.
© 2001 The Washington Post Company