Vioxx recall raises prescribing questions

There are many other treatment options for people with arthritis, and physicians are considering them patient by patient.

By Susan J. Landers, AMNews staff. Oct. 25, 2004.

Washington -- Physicians are pulling out their risk-versus-benefit calculators once more to determine which patients, if any, should be switched to another COX-2 inhibitor in light of the fate of the popular drug Vioxx (rofecoxib), which was pulled from the market abruptly Sept. 30.

Merck & Co., Vioxx's manufacturer, voluntarily withdrew the drug after data from a prospective, randomized, controlled clinical trial pointed to increased cardiovascular risk for patients who took the drug for at least 18 months. "We are taking this action because we believe it best serves the interests of patients," said Raymond V. Gilmartin, chair, president and chief executive officer of Merck.

But this decision has now led some to cast doubt on the safety of other drugs in the same class of COX-2 inhibitors, including Pfizer's Celebrex (celecoxib) and Bextra (valdecoxib).

So far, these questions have not been given an official nod.

"At this time, we have not made any further decisions regarding review of COX-2s already on the market," according to a Food and Drug Administration statement, although the agency is monitoring these medicines closely.

Physicians, however, need to make decisions now, and they are.

"It would surprise me if this is not a class effect," said Michael Fleming, MD, a family physician in Shreveport, La., and president of the American Academy of Family Physicians. He has decided not to prescribe another similar COX-2 drug for his patients who had been taking Vioxx.