Do Two Popular Arthritis Drugs Increase Heart Attack Risk?
Aug. 21, 2001 -- Heart researchers from the Cleveland Clinic Foundation say that the popular arthritis drugs Vioxx and Celebrex may increase the risk for heart attacks and are cautioning doctors to use the drugs very carefully, especially in people with heart disease.
But the makers of the drugs say that the researchers are misinterpreting data and are ignoring many favorable studies of the drugs.
Steven Nissen, MD, says an analysis of existing medical research of the drugs suggests that the people taking them are twice as likely to have heart attacks as people who take older anti-inflammatory drugs to treat arthritis. But Nissen, who is vice chairman of cardiology at the Cleveland Clinic, adds that even with this increased risk, the number of heart attacks is still very low.
The study is reported in the Aug. 22 issue of The Journal of the American Medical Association.
Celebrex and Vioxx are drugs that fight pain and inflammation in the body and are used for arthritis as well as other medical problems such as severe menstrual cramps. These drugs are called Cox-2 inhibitors and are newer versions of older painkillers, such as ibuprofen and naproxen. The newer medications are believed to cause less stomach problems like ulcers and bleeding, so many doctors have been giving their patients Cox-2 inhibitors over the older drugs.
Celebrex and Vioxx have been available since 1999, and with sales expected to top $6 billion this year, both drugs are big moneymakers for their manufacturers. So it is not surprising that these drug companies staunchly defended the drugs.
Steve Geis, MD, PhD, group vice president for clinical research at Pharmacia, the maker of Celebrex, says the study is flawed because Nissen and his colleagues were comparing apples and oranges. He says a better and more accurate approach would be to compare people who take Celebrex to people who are not taking aspirin. Using that method, says Geis, heart attacks would actually be less common in people taking Celebrex.
Laura Demopoulos, MD, senior director of cardiovascular clinical research at Merck, the maker of Vioxx, tells WebMD that the researchers overlooked several studies that showed no increased chance of having a heart attack with Vioxx. She says 19 previous studies have shown that Vioxx is no more likely to cause a heart attack than traditional anti-inflammatory drugs or placebo.
In the current study, Nissen and his colleagues compared Vioxx to the traditional arthritis drug naproxen, which works in a way similar to aspirin. People on Vioxx were twice as likely to have a heart attack than patients on naproxen, says Nissen. But among the 8,000 people in the study, only 161 patients had heart attacks and 70% of them were taking Vioxx.