Vioxx: The Pros and Cons of Other Drugs (cont.)
According to the American College of Rheumatology, people with rheumatoid arthritis are more than twice as likely as osteoarthritis patients to have problems with NSAIDs. Factors that increase your risk for gastrointestinal problems from NSAIDs include being over 60, smoking, having a history of ulcers, having heart disease, and taking anti-inflammatory steroids or blood-thinning drugs.
Theodosakis says people taking NSAIDs regularly should also be concerned about the possibility of losing cartilage, the padding between joints. "This is an issue with all the anti-inflammatory drugs," he says. "They really haven't been studied for cartilage loss adequately, and the evidence we do have is very damning."
Cox-2 inhibitors include Celebrex and Bextra, as well as Vioxx, which was taken off the market due to its heart risks. They are newer kinds of NSAIDs designed to relieve pain without hurting the stomach. They work by inhibiting a specific enzyme called cyclooxygenase-2, or Cox-2. Older NSAIDs covered in the section above not only inhibit Cox-2, but they also suppress Cox-1, an enzyme that may play an important role in protecting the stomach lining.
Since the Vioxx recall, Celebrex and Bextra have come under even more intense scrutiny. Some doctors suspect that dangers posed by Vioxx may extend to all Cox-2 inhibitors.
Pfizer, the company that makes Celebrex and Bextra, has made two important announcements on this issue. On Oct. 18, 2004, Pfizer said it is confident in Celebrex and announced a major new study to assess Celebrex's affect on the heart. The study is planned to start in early 2005. It will look at more than 4,000 arthritis patients who have had a prior heart attack. Pfizer is a WebMD sponsor.
On Oct. 15, 2004, Pfizer also reported that Bextra appeared to increase the risk of serious complications for people abroad who were recovering from heart bypass surgery. In the U.S., the drug is not approved for use in people recovering from heart bypass surgery.