Arthritis Pain Relief Update

WebMD Live Events Transcript

Has the recent news about arthritis pain relievers left you confused and in pain? John H. Klippel, MD, president and CEO of the Arthritis Foundation, joined us on Feb. 23 to answer your questions.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Klippel. We've heard so much about arthritis pain relievers in the past few days.

KLIPPEL:
I think the most important thing is to recognize the prompt action by the FDA and industry in addressing the concerns that have been raised with regards to nonsteroidal anti-inflammatory drugs or NSAIDs, and I think the decisions by the FDA advisory board are in the best interests of the consumer in informing the consumer about benefits and risks of this class of drugs.

MEMBER QUESTION:
What do you think the public's perception of the news about all of the Cox-2 inhibitors either being pulled from the shelves, as in the case of Vioxx, or questioned by the FDA? Are arthritis sufferers afraid to take these medications? What does the Arthritis Foundation have to say about these matters?

KLIPPEL:
I think it has heightened the concern that people have with regard to side effects of drugs. I think there are two main issues. All drugs have side effects and an educated consumer should always ask about side effects. On the other hand, we believe that the major concern of people with arthritis is not the side effects of the drugs but the fact that for many, there are inadequate medicines to control their pain. So we hope this results in a better dialogue between the person with arthritis and their doctor about the benefits and risks of these drugs.

MODERATOR:
Has there ever been a study showing the Cox-2 drugs as being more effective at pain relief than NSAIDs?

KLIPPEL:
That's a very good question. These drugs were developed principally to reduce the risk of gastrointestinal, or GI, side effects. The studies have clearly shown they in fact do result in fewer GI side effects. On the other hand, studies have not shown that these drugs actually relieve pain more effectively than traditional agents. Now, having said that, I think any doctor who prescribes these drugs recognizes that patients respond quite differently to these medications and it is our view that there are patients who have on their own discovered that a particular Cox-2 drug relieves their pain more effectively than any drug they have tried. We believe that's an important consideration and it certainly argues for having the maximum number of medications available so patients can try several before identifying the one that is the most effective for them.

"All drugs have side effects and an educated consumer should always ask about side effects."

MEMBER QUESTION:
Is it true that doses of Celebrex at 200 mg and under are safe, and that the risk is only at higher doses?

KLIPPEL:
That was one of the things that was carefully considered by the FDA Advisory Committee -- the effect of dose. I think the evidence would suggest there is a dose effect for the Cox-2 drugs; that is, the greater the dose the greater the risk of a cardiovascular side effect. We don't find that surprising; that would be predicable based on how these drugs actually work. Certainly one of the recommendations of the Advisory Committee was to use the lowest dose possible that controls arthritis symptoms.

MODERATOR:
Do you think, given the possible cardiac side effects of Cox-2 drugs, that other medications should be tried first?




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