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Life
after Vioxx
Life
after Vioxx
06:55 PM CST on Monday, November 8, 2004
By
ROBIN GALLIANO RUSSELL / Special Contributor to The Dallas
Morning News
If
you suffer from arthritis, you know that mornings are the
worst.
NATALIE CAUDILL/DMN
Doctors say that there are plentiful pain-relieving
alternatives to Vioxx for people who suffer from
arthritis.
The throbbing pain, stiffness and
swelling in your joints make it hard to even get out of bed.
And the right medication can mean the difference between
getting up in minutes rather than hours.
For many of you, relief from pain was spelled V-I-O-X-X.
Vioxx is a COX-2 inhibitor, one in a class of drugs developed
to relieve pain without causing stomach bleeding or ulcers. It
was a hit with arthritis and other chronic pain sufferers.
But when a recent trial showed that Vioxx doubled the risk of
heart attack and stroke in patients who took the drug for more
than 18 months, drug manufacturer Merck pulled it off the
market.
Doctors say they've been deluged with calls since Vioxx was
pulled off the market. They are telling patients there are
alternatives, though it may take some adjustments to get the
combination that works.
"The perception is that newer is better. There are a dozen, 15
medications, in the same class that I can use that accomplish
the same thing," says Dr. John Cush, medical director of the
Arthritis Consultation Center at Presbyterian Hospital of
Dallas and a member of the FDA Advisory Committee.
Other drugs in the same class, including Celebrex and Bextra,
are also coming under scrutiny, however. Drug manufacturer
Pfizer now says that trials of Bextra show an increased risk
of strokes and heart attacks in heart-surgery patients who
take the drug, and it is setting up further studies.
Dr. Cush expects the FDA to undertake a review of COX-2
inhibitors.
Finding a medication that works is no small matter. Arthritis
is one of the most prevalent chronic health problems in
America, causing pain, loss of movement and sometimes
swelling. One in three adults – 70 million Americans and more
than 3.7 million Texans – have some form of arthritis.
Still, doctors are reassuring patients that there are
different combinations to try.
"What it boils down to is this: You have aspirin, that's 100
years old and a wonderful drug, but you take a lot of pills
and there's multiple toxicities. They continue to build a
better anti-inflammatory drug. What they lost was the
blood-thinning aspect that you have in aspirin," Dr. Cush
says.
Many arthritis patients wanted their doctors to prescribe
Vioxx after seeing advertisements on television and in
magazines – "I want Vioxx because Dorothy Hamill uses Vioxx,"
as Dr. Cush characterizes such requests. Television ad budgets
for the drug reportedly topped those for Pepsi, Nike or
Budweiser.
"The marketing of Celebrex and Vioxx exceeded anything that I
can remember," agrees Dr. David Karp, chief of the rheumatic
diseases division at the University of Texas Southwestern
Medical Center at Dallas. "Was it doing any better? I doubt
it. These are different flavors of the same ice cream. There
have always been alternatives."
Dr. John H. "Jack" Klippel, president and CEO of the Arthritis
Foundation, says the loss of Vioxx may not be entirely bad for
arthritis patients. "We actually think it's a good opportunity
for them to step back and work with their rheumatologists and
see what their options are."
Vioxx was developed because it was thought to be safer for the
stomach lining, not because it was more effective with regard
to pain relief, he says.
Rheumatologist Scott J. Zashin of Presbyterian Hospitals
agrees. "When the COX-2 inhibitor drugs came out, the only
patients who should have taken them were the ones with
symptoms of stomach problems." It's a balancing act, Dr. Karp
says, to prescribe a pain relief that also protects the
stomach lining and prevents damage to liver or kidneys.
"There was a very high anticipation for these drugs," Dr. Karp
says. "Then we realized they didn't protect the heart. Then
you take aspirin, then you take something for stomach ulcers
and we're back to where we were. There is no drug that doesn't
have side effects."
Patients who took Vioxx and are now worried that they will
have increased risk for heart problems should rest easy, says
Dr. Emily Isaacs, a specialist in internal medicine and
rheumatology at Harris Methodist Fort Worth Hospital.
"There's no data to suggest that if you took Vioxx in the past
there'd be cardiovascular risk in the future if you stop
taking it now," she says. "And you can find alternatives. It
may take a few adjustments."
Anti-inflammatory medication is effective and well-tolerated
by arthritis patients, she says. Vioxx was a once-a-day drug
that tested well from a gastrointestinal standpoint. But her
patients are trying to switch to another anti-inflammatory
drug and looking at the risk to the stomach.
Dr. Zashin, who also teaches at UT Southwestern, says most of
his patients are looking to switch to different
anti-inflammatory medications as well. For patients with no
swelling, he often recommends nonaspirin salsalate products
such as Disalcid, which have a good gastrointestinal profile
because they have been modified to not upset the stomach.
No
data yet support pulling Celebrex and Bextra off the market,
she adds. Thousands of patients had been studied when those
medications were researched and approved.
Rheumatoid arthritis sufferer Lisa Montes, 45, of Richardson
still hopes Vioxx comes back on the market. For three years
she took it – without side effects – for the swollen joints
and achiness in most of her joints, including her knees, feet,
hands, fingers, wrists and elbows. Daily at first, then only
as needed, maybe twice a week.
It
worked so well that she nearly panicked when the drug was
recalled.
"I
freaked out," she says. "I was concerned. I immediately
stopped taking it. I have a sensitivity in my stomach. This
was the only thing that worked for me."
Now she takes Extra Strength Excedrin each day, but only on a
full stomach. And she stays active, climbing stairs and
parking far from the door at SMU Law Library, where she works.
"I
try to do as much without drugs as possible. But I felt
wonderful" with Vioxx. "I hope they put it back on the
market."
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