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http://www.nytimes.com/2002/06/04/business/04DRUG.html

2 Big-Selling Arthritis Drugs Are Questioned

By MELODY PETERSEN

he number of prescriptions for Celebrex and Vioxx, two heavily advertised medicines for arthritis, is far higher than it should be, based on their apparent narrow benefit over other pain relievers of being safer on the stomach, according to new data from Express Scripts, one of the largest pharmacy benefit management companies.

The two new pain relievers have grown controversial because they have not been shown to fight pain better than older drugs like ibuprofen and naproxen, which are available in generic and over-the-counter versions for a fraction of the price.

In a report released yesterday, Express Scripts said that some studies have justified the high price of Celebrex and Vioxx because they appear to reduce the risk of ulcers, which can be a side effect of taking anti-inflammatory pain relievers. But 74 percent of people taking Celebrex or Vioxx for the first time in 2000 were not considered to be at risk of ulcers, according to Express Scripts. The statistic was based on the millions of prescriptions filled by Express Scripts each year.

"These drugs are being used inappropriately," said Dr. Emily Cox, manager of outcomes research at Express Scripts. "There has been no study to show they are more effective."

But Pharmacia, which sells Celebrex and Bextra, a similar drug that was introduced this year, and Merck & Company, the maker of Vioxx, said they disagreed with Express Scripts' contention that the medicines were being overprescribed.

The companies said that most patients who develop serious ulcer complications while taking other pain relievers do not have symptoms that would warn them that they are at risk.

"The vast majority of people at risk do not have previous warning," said Gregory Reeves, a spokesman for Merck.

And while the risk of ulcers increases the longer a patient takes a pain reliever like ibuprofen, the companies said, some people taking the older drugs for just a few days have also suffered stomach problems.

"There have been reports that after one day of therapy, a patient could have a complication," said Dr. John G. Fort, Pharmacia's vice president for global medical affairs.

Express Scripts said it was recommending that its clients, which include many employer health plans, require patients who are not at risk of ulcers to try a generic pain reliever before taking Celebrex, Vioxx or Bextra, which are known as Cox-2 inhibitors. People at risk are often older, Express Scripts said, and have a history of ulcers or other stomach problems.

Dr. Brenda Motheral, senior director of outcomes research at Express Scripts, said that the heavy promotion of these drugs on television and to doctors may be behind excessive prescribing. There is also a misperception, she said, that new drugs are always better.

Inappropriate use of the drugs is costing the health care system millions of dollars, Dr. Motheral said. "There are probably better ways to spend those dollars," she said.

 

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