Cox-2 Drugs Overused, Research Shows
An expensive class of painkillers called Cox-2 inhibitors was widely overprescribed and over-used before evidence surfaced linking them to an increased risk of heart attack and stroke, a study reports.
The drugs were designed as an alternative to over-the-counter painkillers for people at increased risk of developing stomach ulcers and other problems. But Cox-2 inhibitors quickly became popular among patients who had little or no risk of such gastrointestinal problems, according to the study, which will appear Monday in the Archives of Internal Medicine.
Cox-2 inhibitors were even widely used among patients with congestive heart failure or liver or kidney dysfunction, conditions that should have prompted restricted use of the drugs.
Most studies have shown that Cox-2 inhibitors are generally no more effective than over-the-counter painkillers such as ibuprofen and aspirin. But the Cox-2 drugs, which were heavily advertised to consumers, cost 15 to 18 times as much. Cox-2 inhibitors are believed to inhibit the production of an enzyme that produces gastric inflammation.
“What we saw was widespread, rapid adoption of an interesting and promising but expensive and largely untested medication by millions of people with little or nothing to gain from long-term use,” said Dr. G. Caleb Alexander of the University of Chicago, lead author of the study.
Merck & Co. withdrew its arthritis drug, Vioxx, from the market in late September after studies revealed that it nearly tripled the risk of heart attacks. Pfizer Inc. announced in December that it would keep its primary Cox-2 inhibitor, Celebrex, on the market but would stop advertising the drug to consumers.
Alexander and his colleagues studied two patient surveys, comparing prescriptions for nonsteroidal anti-inflammatory drugs, or NSAIDs, and Cox-2 inhibitors, a NSAID subset, with treatment guidelines that stratified patients by risk of gastrointestinal symptoms.
About 31% of patients had a “very low risk” of such effects and 42% had a “low risk.” Neither group should have received Cox-2 inhibitors, according to the study.
Nonetheless, by 2001, 40% of those in the lowest-risk category were receiving Cox-2 inhibitors, and by 2002, 66% of those in the next-lowest category were receiving the drugs.
