A new study conducted by RxIntelligence, a non-profit research organization founded by the Blue Cross and Blue Shield Association, examined Rofecoxib (Vioxx®) and celecoxib (Celebrex®) in comparison to non- steroidal anti-inflammatory drugs (NSAIDs)such as Motrin (ibuprofen) and Naprosyn (naproxen). The review was presented at the European International Society for Pharmaceutical Outcomes Research meeting in Cannes, France.
RxIntelligence’s analysis did not find significant differences in pain reduction in a systematic literature review and meta-analysis of 36 clinical trials. Celecoxib and rofecoxib are part of a class of drugs called selective COX-2 inhibitors. COX-2 inhibitors frequently are prescribed to patients who have experienced side effects, specifically gastric ulcers from using NSAIDs for pain relief.
The study revealed that patients treated with rofecoxib or celecoxib were at lower risk for gastric ulcers during the first year of treatment than patients treated with traditional drugs. They reduced the risk of ulcer complications requiring hospital care from 1.5 percent to less than 1 percent of patients. However, the total number of side effects was comparable, although patients treated with rofecoxib (25 mg/day) were more likely to experience hypertension than those treated with traditional drugs.
“While direct-to-consumer advertising implies that some new drugs are better than existing therapies, this study shows COX-2 inhibitors are about the same at treating the symptoms of osteoarthritis or rheumatoid arthritis,” said Michael O. Fleming, M.D., RxIntelligence board chairman. “They do substantially lower the risk of ulcers in arthritis patients. But for people who are not at risk of ulcers, the older, less costly drugs provide the same pain relief at lower cost.”
In an economic evaluation, treatment costs for selective COX-2 inhibitors were found to be substantially higher than for the traditional NSAIDs, but may still be appropriate for patients with two or more risk factors for gastric ulcers such as age, history of GI ulcers, or use of cortisone. The economic analysis showed that in these specific cases it is more cost-effective to use selective COX-2 inhibitors alone than to use a combination of non-selective NSAIDs with other drugs protecting for ulcers (misoprostol or proton pump inhibitors).