Doctors Don’t Miss Vioxx ; Alternatives Exist for Arthritis Drug

BLOOMINGTON — There is life after Vioxx for the hundreds of Central Illinois residents.

The anti-inflammatory drug was pulled last fall because it increased patients’ risk of heart attack and stroke. Now, patients have several options.

Some are doing fine on their new therapy. Others are in pain.

“We don’t want people to just stop taking everything (all medicines),” said Karen Ferguson, director of the McLean County Branch of the Arthritis Foundation. “They need to talk with their doctor.”

“The majority of my patients who were on Vioxx are now taking Celebrex or Bextra and are maintaining,” said Dr. Joseph Newcomer, an orthopedic surgeon with Orthopedic & Sports Medicine Center in Normal and Pontiac.

“Given in recommended doses, those medicines are safe,” he said.

Dr. Stephen Belgrave, a family practice physician at Carle Clinic in Bloomington, said many of his patients who had been prescribed Vioxx now are taking Celebrex or another anti-inflammatory medicine and most are doing fine.

Vioxx, Celebrex and Bextra are in a class of anti-inflammatory drugs called cox-2 inhibitors that relieve joint pain without causing stomach or gastrointestinal problems. Vioxx was the most popular and was prescribed for people with chronic osteoarthritis and rheumatoid arthritis as well as those with severe muscular strain or ligament sprain.

In a typical orthopedic practice, 50 percent to 70 percent of patients are on an anti-inflammatory drug, Newcomer said.

Many patients take traditional anti-inflammatory medicines, such as ibuprofen, which includes Advil and Motrin. But those who couldn’t because of increased risk of stomach ulcers were prescribed Vioxx, Celebrex or Bextra, Newcomer said.

The Vioxx announcement surprised Newcomer and Belgrave even though most of their patients weren’t on Vioxx at the time. Neither doctor was aware of any patients having heart complications from Vioxx.

Only 5 percent to 10 percent of Newcomer’s patients were on Vioxx.

“I was already making the move from Vioxx to Bextra because Bextra seemed to work better for my patients,” he said. “But there were those patients who absolutely loved Vioxx.”

Only about 5 percent of Belgrave’s patients were on Vioxx and other cox-2 inhibitors. They were arthritis and severe muscular strain patients who were at high risk of a gastrointestinal bleed and who didn’t get relief from Tylenol.

Since Vioxx was removed, Belgrave patients at high risk of a gastrointestinal bleed were prescribed Celebrex. Most of Newcomer’s Vioxx patients have switched to Celebrex or Bextra.

Federal scientists announced a month ago that Celebrex raises the risk of heart attack when taken at high doses and ordered a review of all studies of cox-2 drugs.

But the drug wasn’t pulled and Newcomer asserted that Celebrex is “very safe when given in recommended doses.”

Belgrave makes sure patients understand that there may be an increased cardiac risk with Celebrex, although it hasn’t yet been proven. Patients at risk of coronary artery disease may be prescribed a standard anti-inflammatory, such as Relafen or Clinoril, which must be taken with a heartburn medicine, such as Prilosec or Prevacid, Belgrave said.

Another recent announcement contended Bextra causes skin lesions. “I have several hundred people on Bextra and have never seen that,” Newcomer responded.

Patients who have chosen not to take Celebrex or Bextra and who can’t take ibuprofen are dealing with their pain with Tylenol Arthritis or Extra Strength Tylenol in conjunction with heat or ice, and water- or land-based exercise programs, such as those offered by the Arthritis Foundation.

Belgrave also recommends exercise and other therapy that takes the focus off the drugs.