Best Drug for Arthritis Carries Heart Attack Risk
Drugs which have been linked to an increased risk of heart attacks and strokes may still be the best option for treating arthritis, experts said yesterday.
In September 2004, the drug Vioxx was withdrawn from the market by makers Merck amid fears about increased cardiovascular risks in patients.
Concerns have been been raised about the whole class of drugs, which are called cyclo-oxygenase-2 (COX-2) inhibitors, leading to strong warnings being given to doctors and patients about the risks linked to their use. Now a review by researchers from Imperial College London and Queen Mary, University of London, suggests that they may still be the best option for treating some forms of arthritis.
Writing in Nature Reviews Drug Discovery, they argued that although the drugs have been linked to increased risks of heart attack and stroke in some patients, the same may be true for traditional non-steroidal anti-inflammatory drugs (NSAIDs).
All NSAIDs, including the COX-2 inhibitors, work by blocking the actions of the COX-1 and COX-2 enzymes.
Blocking the COX-2 enzyme relieves inflammation and pain, but blocking COX-1 can increase the risk of stomach ulcers and bleeding.
This led to the development of COX-2 inhibitors, which were designed to keep the benefits of inhibiting the COX-2 enzyme but cut out the gastric side-effects linked to the inhibition of COX-1.
The researchers looked at more than 100 papers on the drugs, as well as the recommendations from organisations such as the American Federal Drugs Administration. They said that calls to remove all COX- 2 inhibitors and return to using NSAIDs could cause additional problems.
The researchers said that although NSAIDs had been marketed for several years, they had never been required to meet the clinical trial standards now set for COX-2 inhibitors, meaning they may not be any safer.
Prof Jane Mitchell, from Imperial College London, said from existing evidence, COX-2 inhibitors may be the best option for some patients.