Vioxx Exits The Market

A New York Times editorial on October 1, 2004 said:

Merck bowed to the inevitable yesterday when it pulled Vioxx, an arthritis and pain relief drug with $2.5 billion in sales last year, from the market. Evidence that Vioxx may increase the risk of heart attacks and strokes has been accumulating for years, but Merck had always managed to explain it away. The coup de grāce was supplied by new data from a long-term clinical trial that unequivocally showed a small risk of cardiovascular harm in patients taking the drug longer than 18 months. It was the latest twist in a sorry tale of how drugs in this class, known as Cox-2 inhibitors, have been oversold.

The stock price of Merck plunged 27% on the news, which reduced the company's stock market value by $25 billion.

Who takes Vioxx?

We will cite some survey data from the 2004 MARS OTC/DTC Pharmaceutical Study.  This is a mail survey of 21,054 adults in the United States conducted during the first quarter of 2004.  Within the study, 5.0% of the respondents indicated that they had taken Vioxx during the past twelve months.  In the chart below, we show the incidence of Vioxx usage by current health status and current health conditions.

(source: 2004 MARS study)

What are the options for these people who suffer from painful conditions?  Gina Kolata wrote in the New York Times:

Not everyone who takes Vioxx does so for 18 months or longer. Or even daily. Some arthritis patients take it only during flare-ups. And other people might take it only for several months, after a sports injury, for example. Medical experts say that it is safe for patients to abruptly stop taking Vioxx, adding that there are many alternatives to the drug, including cheap over-the-counter drugs. One of those, aspirin, is much cheaper than Vioxx, which has sold for $2.50 or more a pill. Vioxx provides about the same pain relief as aspirin, although studies showed that patients taking Vioxx were less likely to develop ulcers or gastrointestinal bleeding.

There are also two prescription drugs, Celebrex and Bextra, both made by Pfizer, which are similar to Vioxx but have not been shown to pose cardiovascular risks. That, and Pfizer's extensive advertising, may help explain why sales of Celebrex have lately been twice those for Vioxx. The F.D.A. says, however, that studies of Celebrex and Bextra have lasted only a year, and the Vioxx study found risks only after people had taken it for 18 months.

Within the MARS study, 5.3% of the survey respondents said that they used Celebrex and 1.9% used Bextra in the last 12 months. As high as those incidences of Vioxx usage are among those in poor health due to current health conditions, the cross-brand usage incidences are even higher.  31% of Bextra users and 26% of the Celebrex users have also used Vioxx in the last 12 months.  This usually does not mean that a person is concurrently taking different brands of pain relievers, which may have unforeseeable interactions.  But does that mean that the drugs are interchangeable.  Gina Kola reported:

[Dr. Michael Lockshin] added, however, that some of his patients might have difficulty finding an alternative to Vioxx. Pain relief, he said, is idiosyncratic and unpredictable. "Some patients respond beautifully to one drug and not to another."

(posted by Roland Soong, 10/2/2004)

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