Americans abandon Vioxx, Celebrex, Bextra

Nearly two-thirds of patients who were taking a COX-2 inhibitor drug prior to the Vioxx recall and Celebrex/Bextra study findings have abandoned this class of pain medication, according to a new poll by Spine-health.com that provides in-depth information and resources for patients with back pain, neck pain, and a full range of spinal disorders. (Related article: Merck did not allow Vioxx label changes to highlight risks)

The poll of 375 back pain patients who were taking Celebrex, Bextra, or Vioxx shows that only 36% are still taking some brand of COX-2 inhibitors. 42% switched to other pain medications (e.g., Aleve, Advil, Bayer, Tylenol), and 9% switched to non-drug pain relievers (e.g., herbal/dietary supplements). Surprisingly, 13% are forgoing any medication until more safety information is available. (Related article: Is Mobic a safe alternative to Vioxx, Celebrex, Bextra?)

"This poll illustrates the high level of concern among patients about the potential side effects of Cox-2 inhibitors," says Andrew Cole, M.D., a physiatrist in Bellevue, Washington. "And the side effects can't be ignored - studies show a significantly increased risk of heart attack and stroke, especially for those patients who are elderly or who have taken the drugs for long periods of time. Bextra also potentially carries the risk of blood clots and a serious skin reaction." And what patients may now realize is that COX-2s don't necessarily alleviate pain any better than other pain medications, including those available over the counter. (Related article: Americans lose trust in FDA after Vioxx recall)

The controversy that started after Vioxx recall and revelations that Celebrex and Bextra also have serious side effects has rattled the confidence that Americans had in the FDA. The trust tanked further after disclosures that the decision to put Vioxx back on the market and to leave Celebrex and Bextra on pharmacy shelves was actually taken by drug industry insiders chosen by the FDA. It appears that FDA no longer cares for American people's lives and health and is more committed to protecting the interests of the drug industry. (Related article: FDA panel recommendations in doubt after reports of conflict of interest of members)

COX-2's do remain a viable and perhaps preferred option for certain patients, such as those at risk for ulcers. "What medications to take is really a case-by-case decision that each patient needs to make with the guidance of his or her doctor, since so many individual factors come in to play, including the patient's medical condition, clinical situation, age, lifestyle and past experience with medications," adds Dr. Cole. (Related article: Making sense of FDA panel recommendations on Vioxx, Celebrex, and Bextra)

The following principles should be considered when re-evaluating a patient's medication plan:

1. When doctors or patients have any concerns about a medication based on new medical findings or media comments, they should talk openly with one other;
2. Even if the patient's conditions improve, it may not be prudent to reduce or discontinue their medications;
3. Medications should be used in the lowest dose that is effective; and
4. Since there is no universal substitute for any particular drug, each patient requires a personal evaluation to discuss alternatives.

Changing or discontinuing a pain medication is a major decision that significantly impacts quality of life for people with chronic back pain or arthritis. This poll suggests that information about side effects made available to the public was powerful enough to cause flight from an entire class of drugs (and even from any drug), despite the potential for increased pain.

Recommended article: Merck has a weak defense in Vioxx class action lawsuits

Source: Spine Health