'Vioxx Like' Drugs May Still Be Best Option for Arthritis, Write Scientists

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'Vioxx Like' Drugs May Still Be Best Option for Arthritis, Write Scientists

SOURCE: Imperial College London

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Scientists believe that despite the current concerns around

anti-inflammatory drugs like Vioxx, they may still be the best option for

treating some forms of arthritis.

In a Nature Reviews of Drug Discovery article this month the researchers

from Imperial College London and Queen , University of London examine

the use of selective inhibitors of cyclo-oxygenase-2 (COX-2).

They argue that although this class of drugs, which includes Vioxx, has been

associated with an increase in the risk of cardiovascular events such as

heart attacks and strokes in some patients, the same may be true for

traditional non-steroid anti-inflammatory drugs (NSAIDs).

All NSAIDs, including COX-2 inhibitors, work by blocking the actions of both

COX-1 and COX-2 enzymes. Blocking COX-2 relieves inflammation and pain, but

blocking COX-1 can increase the risk of gastric ulcers and bleeds. For this

reason COX-2 selective drugs were developed with the simple aim that they

would retain the therapeutic actions of NSAIDs (linked to inhibition of

COX-2) but lose the gastric side effects (linked to inhibition of COX-1).

The researchers reviewed over one hundred papers on the subject and looked

at the latest recommendations from organisations such as the American

Federal Drugs Administration on the use of COX-2 inhibitors and NSAIDs.

The researchers point out that the calls for the removal of COX-2

inhibitors, and a return to using NSAIDs, may cause additional problems.

Although NSAIDs have been marketed for a number of years, they have never

been required to meet the clinical trial standards now set for COX-2

inhibitors, meaning they may not be any safer.

Professor Jane , from Imperial College London, and one of the

reviews authors, said: " Although some COX-2 drugs have been reported to

increase the risk of heart attack and stroke, they may still remain the best

option for treating arthritis in some patients without cardiovascular risk

factors who cannot tolerate traditional NSAIDs because of gastric side

effects. "

Professor added: " This review shows us that despite the large scale

use of NSAIDs and COX-2 inhibitors for a number of years, we still need more

information on their benefits and potential risks and that more research

needs to be done in this area. Looking at existing evidence, however, it

would seem COX-2 inhibitors may be the best option for some patients. They

are as effective as traditional NSAIDs, but with less gastric side effects

than some older drugs. "