Monday, December 20, 2004

COX-2 Inhibitors

The golden age of COX-2 inhibitors is over. Vioxx (produced by Merck) was recently pulled from the market due to its increased cardiovascular risk. Bextra and Celebrex (produced by Pfizer) have also been found to increase cardiac events. The COX-2 inhibitors were no more efficacious than the non-selective nonsteroidal antiinflammatory drugs (ibuprofen, naprosyn, etc) but did have a lower risk of GI bleeding.
It would be interesting to see an analysis of the mortality rate expected from taking a nonselective NSAID (such as ibuprofen-advil) for a year versus taking Celebrex for a year. In other words, would more people be expected to die from ibuprofen-induced GI bleeds than Celebrex-induced GI bleeds and heart attacks?
Of course, ibuprofen vs. Celebrex is not the only option. Ibuprofen can be combined with one of the proton pump inhibitors (Prilosec, Nexium, Prevacid) to significantly lower the incidence of GI bleeding. I expect to see the stock price of AstraZeneca (Nexium) and Procter + Gamble (Prilosec) rise in the next few weeks.


Anonymous said...

I'm just a patient (who isn't afraid of med journals), but am curious about this if any of the docs want to answer. There are lots of places around the net giving the figure of 16,000 Americans dying every year from NSAID's. This makes ibuprofen, naproxen, and aspirin, taken collectively, roughly as serious a public health menace as murder. And you can buy this stuff without a prescription?

I guess what I am saying is that, while I'm sure ibuprofen deaths occur, this 16,000 almost has the air of urban myth about it. However, I will be glad to be proven wrong by some solid journal citations.

Anonymous said...

I've seen at least 16000 many times, and whereas I'm in intense pain and can't search around too much, here's one study that puts it at 7600 for 8 years ago.

It's not an urban myth.

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