Celebrex Less Risky Than Vioxx
By SCOTT HENSLEY
Staff Reporter of THE WALL STREET JOURNAL
December 7, 2004; Page D6
The painkillers known as Cox-2 inhibitors don't all carry the same risk for heart attacks, a study involving more than 8,000 people suggests.
The research from scientists at the University of Pennsylvania found that Vioxx was almost three times as likely to be associated with a nonfatal first heart attack as Celebrex.
The findings indicate that the risk of heart attack and stroke seen with Vioxx may not extend to all drugs in the class of Cox-2 medicines, as some other work has suggested.
Merck & Co., Whitehouse Station, N.J., pulled Vioxx from the market after a study found that after 18 months of use it doubled the risk of heart attack and stroke compared with a sugar pill. That action has spurred patients and doctors to ask if other Cox-2 medicines are equally risky.
"I used to be quite a believer in class effects, but the more studies that come out showing a difference within classes, the more you wonder whether you can always assume a class effect," said Stephen E. Kimmel, associate professor of medicine at the University of Pennsylvania and lead author of the paper.
Pfizer Inc. makes Celebrex and Bextra, the Cox-2 drugs remaining on the U.S. market. The New York drug maker has stood by the safety of both medicines. Pfizer has pledged to fund a prospective study of Celebrex compared with a placebo to see if the drug may protect against heart attacks. The company also has said it would assess the cardiovascular safety of Bextra, which increased the risk of heart attack in a study of patients recovering from coronary bypass surgery.
The latest results appeared in the online edition of Annals of Internal Medicine yesterday.
The study involved more than 1,700 patients, aged 40 years to 75 years old, who suffered a first heart attack that didn't kill them between May 1998 and December 2002. A comparison group of 6,800 patients was culled from the same five counties where these people lived. In the heart attack group, 27 patients had taken Vioxx, 18 had taken Celebrex and 1,354 patients hadn't taken either of those drugs or other nonsteroidal anti-inflammatory drugs, such as ibuprofen.
Vioxx users had a 16% higher risk of nonfatal heart attacks than nonusers, an increase that wasn't statistically significant, however. By contrast, Celebrex users had a 57% lower risk of heart attack compared with nonusers, which was statistically meaningful. In the final analysis, the odds of a Vioxx user having a heart attack were 2.72 times higher than a Celebrex user, after adjustment for several factors, including body mass. That finding also was statistically significant.
The study was funded by grants by the National Institutes of Health, Merck and Pfizer.
A Merck spokesman said, "Observational studies on the risk of cardiovascular events with Vioxx have had inconsistent results, and this study only adds to that literature." A Pfizer spokeswoman said the findings are "consistent with the data we've amassed."
Write to Scott Hensley at scott.hensley@wsj.com
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