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."

E-mail rrscribe@excite.com

Online at: http://www.dallasnews.com/sharedcontent/dws/fea/healthyliving/stories/110904dnlivarthritis.46e6f.html
 

Kraft & Associates

2777 Stemmons Freeway
Suite 1300
Dallas, Texas 75207

Dallas: (214) 999-9999
Fort Worth: (817) 999-9999
Toll Free: (800) 989-9999
FAX: (214) 637-2118
E-mail: info@kraftlaw.com

Please direct general business inquiries to:
Ms. Nita Maki, Office Administrator
nmaki@kraftlaw.com