Vioxx and Bextra and Lawyers, Oh My!

The news has been full of reports recently about health problems related to Vioxx, Bextra, Celebrex, and other cox-2 inhibitor pain killers. Personal injury lawyers are putting up ads all over the place to drum up business. Do a Google search for any three of those names and the page will be full of lawyers advertising for clients.

So what is all the fuss really about?

These drugs are nonsteroidal anti-inflammatory drugs, or NSAIDS. NSAIDS include Bextra, Mobic, Ibuprofen, Daypro, Naprosyn, Celebrex, and Vioxx, and aspirin. Over 50 different NSAIDS are currently available in the U.S.

Aspirin, of course, has been used for years for headaches, arthritis, general pain relief, and fever reducing. But aspirin can cause bleeding in the digestive system. When Vioxx was invented, it was marketed as an alternative that was safer. Then Celebrex and Bextra came along, but they turned out to be no safer than aspirin for the stomach.

The new drugs target an enzyme called cyclooxygenase-2, more commonly abreviated as COX-2. The hormone prostaglandin is a major regulator of pain and inflammation. It is produced in the body from the omega-6 fatty acid arachidonic acid. Enzymes convert arachidonic acid into prostaglandins, thromboxanes, prostacyclin and leukotrienes, all important bioactive substances. The enzymes that do this include cyclooxygenase, lipoxygenase, and peroxidase.

NSAIDs generally work by inhibiting cyclooxygenase. The problem is that there are several prostaglandins that are inhibited, not just the ones that regulate fever and pain. The prostaglandins that are responsible for the protective mucus lining in the stomach and intestines are made using one form of cyclooxygenase (COX-1), and the prostaglandins that are responsible for pain and inflammation are made using another form (COX-2).

So, pharmaceutical companies set out to make substances that would inhibit COX-2 without interfering with COX-1, so there would be less damage to the protective mucosal lining in the gut. Vioxx came along, and was followed by 50 others. People got rich.

Aspirin is also known to have protective effects against heart disease, through a number of mechanisms, one of which is reducing inflammation. In studies on the new COX-2 pain killers, when comparing them to Naproxen sodium (Naprosyn), it was found that Naprosyn had fewer bad effects on the heart than the newer drugs. At first this was attributed to Naprosyn having aspirin-like protective qualities for heart disease. But after more study, it came out that some of the new COX-2 inhibitors were actually causing problems.

That's when regulators and lawyers came in, followed by news reporters, and more lawyers.

So now you know.