Word: coxes
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...problem in older patients. "I like to use low-dose opioids in the elderly because there aren't any liver effects, there aren't any cardiac effects, and the biggest problem you have is some constipation," which you can treat. On the other hand, Palmer believes that the COX-2 drugs are much safer in the young than in the old. "I'll bet if you break down all those Bextra, Celebrex and Vioxx studies and look at the age group under 40 vs. the age group over 70, you're going to see dramatic differences." The problem, she says...
Those concerns were answered last week by a series of studies that showed an increased risk of heart problems in users of not just Vioxx but Celebrex and Bextra as well, and by FDA advisory panels that recommended stronger warnings for the whole class of pain relievers known as COX-2 inhibitors. "The cardiovascular problems appear to be a class effect," says Dr. Eric Topol, director of cardiovascular medicine at the Cleveland Clinic. "But the magnitude of risk does seem to differ from drug to drug." It's now up to the FDA to decide whether the dangers, which...
...findings--which confirmed what many scientists have long suspected but that drug companies desperately tried to deny--make sense, given the way that the drugs work. COX-2 inhibitors were designed to bypass the side effects of aspirin and other nonsteroidal anti-inflammatory agents, which can rip through the stomach lining. In the 1990s, researchers discovered that COX appears in the body in two different forms. COX-2 inhibitors, as their name implies, were designed to block just the inflammatory functions of the COX-2 enzyme, leaving the stomach-protecting functions of the COX-1 form intact...
...scientists thought. Animal studies suggest that COX-2 also promotes chemical reactions that churn out prostacyclin, a protein that keeps blood vessels dilated and keeps platelets from clumping together to form blood clots. Doctors believe a drop in prostacyclin may also be behind the increased incidence of heart attacks and strokes in COX-2 users. In separate studies published in the New England Journal of Medicine last week, researchers found that high-dose Celebrex users were three times as likely as nonusers to die from a heart or stroke event, while those taking Vioxx had twice the chance of suffering...
...will be looking closely for similar risks when the next three COX-2 inhibitors in the pipeline--Merck's Arcoxia, Pfizer's Dynastat and Novartis' Prexige--come up for review in a few years. This time they hope to discover potential problems before the drugs are approved, not after. --By Alice Park