New Drug Treats Arthritis, Easy on Stomach
But Huge Trial Raises Questions Over Value of Prexige
Pain, Ulcers, and Heart Disease continued...
more study is needed. Falk argues that the study included too few heart
patients to prove that Prexige is safe for the heart. He also says the study
offers little new information about patients at high risk of heart disease
and/or digestive system complications.
all had great hopes for this coxib class of drugs to eliminate our problems,
but they don't," Falk says. "There is a group of people for whom
coxib treatment makes sense. ... The million-dollar question is what to do
about patients at high risk. These studies don't answer that. We worry about
people whose age is over 65. We worry about people with prior ulcers or
gastrointestinal complaints. We worry about people on steroids. We worry about
people on high doses of NSAIDs or aspirin. All those questions need to be
Schnitzer, MD, PhD, professor of medicine and assistant dean for clinical
research at Northwestern University, is the lead researcher of the paper
reporting the study's main findings. He says Falk asks excellent questions but
that no single study could answer them all.
believe this study shows that coxibs can prevent meaningful, serious,
gastrointestinal events," Schnitzer tells WebMD. "Even to the extent
seen here, it has major clinical meaning in high-risk patients. But this study
is not directed to answer every question about these patients. If I have a
patient on aspirin at relatively high risk of gastrointestinal complications
who requires an analgesic agent, I think the choice of a coxib is arguably a
better choice based on these data." But he adds that these patients at high
risk of developing an ulcer should consider taking a medication to protect
their stomach along with their coxib.
All of the
experts who spoke with WebMD about this study agree on several
Patients who are at
low risk of heart disease and who don't take aspirin can benefit from coxibs --
if they can afford the high price of these drugs.
Patients who take
low-dose aspirin and also take pain relievers, even coxibs, may need to take
other drugs for stomach protection.
need individual treatment. Doctors must look at each patient's risk factors
before prescribing any of the medications.
warns arthritis sufferers and their doctors not to focus solely on the relative
merits of drug treatments.
talking about managing people with pain due to osteoarthritis, everybody agrees
on patient education, exercise, losing weight, mechanical factors -- the
lifestyle approach," he says. "When you are down to giving painkillers,
everybody agrees that acetaminophen has to be the first tablet for pain relief.
In the U.K., we also consider topical creams because they are safe. And there
are other things to try before using traditional NSAIDs and coxibs. They come
lower down on the list -- they are not the one thing everybody
Prexige is made by
Novartis, a WebMD sponsor.