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Doctors Cautious on COX-2 Drugs in Wake of Vioxx Withdrawal, Pri-Med Survey Finds; Potential ``Class Effect'' a Concern When Treating Patients With Heart Issues

Posted on: Wednesday, 10 November 2004, 12:00 CST

In a nationwide study of primary care physicians conducted by Pri-Med Institute, 84% of doctors surveyed said they are confident in the safety of switching patients from Vioxx to alternative COX-2 inhibitors Celebrex or Bextra so long as heart disease is absent.

Vioxx, a $2.5 billion a year painkiller from Merck & Co., was voluntarily withdrawn from the market on September 30th based on evidence linking the drug to increased incidence of heart attacks and strokes in patients with concurrent hypertension or cardiovascular disease. Vioxx competitors, Celebrex and Bextra, are both manufactured and marketed by Pfizer. The Pri-Med Institute study was conducted two weeks after the announcement.

Prior to its withdrawal, 94% of physicians surveyed reported prescribing Vioxx for patients suffering from a wide spectrum of conditions, including osteoarthritis, rheumatoid arthritis, acute back strain, sports injuries, dysmenorrhea, migraine and post-operative pain. Unlike aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDS), long-term use of COX-2 inhibitors reduces the risk of gastric bleeding and kidney damage.

Concerns about the Drug Class

Almost two out of three physicians surveyed believe that COX-2 inhibitor drugs may prove to pose greater risk of heart attack and stroke as a class. However, the vast majority believe their effectiveness in relieving chronic pain warrants continued use by arthritis patients who do not show evidence of heart disease.

On average, physicians surveyed reported switching their Vioxx patients with less chronic or severe pain conditions, such as back and sports injuries or dysmenorrhea, to over-the-counter drugs ibuprofen and naproxen. Post-operative patients were reported to have been switched to opiates.

"Until any side-effect issues are clarified by further research, we would expect to see physicians throughout the US carefully matching each patient's profile against alternative drugs such as Celebrex and Bextra and widely available NSAIDS," according to Marissa Seligman, Pri-Med Institute vice president.

While there are three new COX-2 inhibitor drugs now in late clinical trials, the Pri-Med Institute survey found little awareness of them among practicing physicians. "It is important that studies be undertaken now to demonstrate that these new drugs are safe for use by people with cardiovascular disease before they are introduced in the market," reported Anne Goodrich, Pri-Med Institute research director.

The Pri-Med Institute plans further studies in coming months among primary care physicians to track trends in the perceptions and usage of COX-2 inhibitors for chronic pain management.

Information provided by Pri-Med. Pri-Med is the leading continuing medical education provider for primary care practitioners, psychiatrists and pharmacists in the United States. With a nationwide network of over 85 programs, Pri-Med has delivered world class continuing medical education over the last ten years to more than 125,000 clinicians locally.

Source: Business Wire

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