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Doctors and Patients Weigh Alternatives to Vioxx
January 18, 2005
By: Steve Siwy for Knee1.com
Doctors and patients find themselves having to reassess their arthritis treatment strategies now that Merck & Co. has recalled the popular arthritis drug Vioxx. Merck announced the recall after one of their own studies showed that Vioxx, a type of arthritis medication known as a cox-2 inhibitor, increased patients’ risk of stroke and heart attack.
Now, many arthritis patients and their doctors are searching for a new treatment to replace the recalled medication. Do they switch to another cox-2 inhibitor? Abandon cox-2 inhibitors as a class and move to over-the-counter pain drugs and anti-inflammatories? Seek alternative medical treatments? Different patients are finding different solutions.
Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking both types of the enzyme cyclooxygenase, known in abbreviated form as cox. NSAIDs have been known to cause gastrointestinal problems, however, because the form of cyclooxygenase called cox-1 protects the stomach. Cox-2 inhibitors, as their name suggests, block more of the cox-2 type than cox-1, and thus cause fewer stomach problems than NSAIDs like ibuprofen or naproxen.
The inhibition of cyclooxygenase also leads to a reduction in prostaglandin, a type of lipid instrumental to the process of causing pain and inflammation. The kind of prostaglandin suppressed, however, also serves the function of protecting the cardiovascular system from another, damaging type of prostaglandin, according to Dr. Garrett FitzGerald of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania. “By taking away the good one, you exaggerate the bad effect of the bad one,” he told the Canadian Press.
Some patients have found the news of Vioxx to be enough of a cause for concern to foreswear altogether the use of cox-2 inhibitors. For others, those cox-2 drugs still available are considered to be a viable alternative. Though he believes that they probably also have some cardiovascular risks to them, Dr. Don Goldenberg, chief of rheumatology at Newton-Wellesley Hospital in Massachusetts, told the Boston Globe that those risks can be limited if the drugs are prescribed only to those with strong cardiovascular systems. Pfizer, maker of cox-2 inhibitors Celebrex and Bextra, has also released statements defending their medications, pointing to their own studies which they say have not shown their products to have the same cardiovascular risks for which Vioxx has been recalled.
Some of those who can’t or prefer not to switch to another cox-2 inhibitor are instead turning to over-the-counter NSAIDs to treat their arthritis pain. Especially for those patients who have not had a history of ulcers or gastrointestinal bleeding, some doctors see the over-the-counter NSAIDs or pain relievers like acetaminophen as a viable alternative to prescription cox-2 inhibitors. The Globe reports that TAP Pharmaceutical Products, Inc. has even begun marketing a combination package containing the NSAID naprosyn along with Prevacid, a prescription antacid, to limit the stomach-damaging effects of the pain drug.
Patients and doctors have not limited themselves to medication when seeking alternate treatments, of course. Many doctors stress prevention as a major step in fighting arthritis, noting that being overweight can put extra stress on joints. Paying attention to diet and exercise can help patients keep their weight down if necessary, while exercise provides the additional benefit of increased strength and flexibility.
Whatever the decision, “It is very important that patients take the opportunity to have a serious discussion with their physician about what drug is going to replace Vioxx,” Dr. John H. Klippel of the Arthritis Foundation recently told ABC News. “It’s also a good time for people to ask about other ways their arthritis can be treated.”
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