UCLA study points to Cox-2s alternatives

The UCLA and Veterans Affairs Greater Los Angeles Healthcare System study demonstrated that for arthritis sufferers at high risk for gastrointestinal problems who traditionally may have used a drug like Merck & Co’s Vioxx, the most cost-effective and safest treatment is actually a common painkiller combined with an acid-reducing drug.

The study used a sophisticated economic model to develop patient scenarios and compare costs of three therapies often used for treating pain from chronic arthritis: 1) a nonsteroidal anti-inflammatory drug alone, such as naproxen (Bayer’s Aleve) or ibuprofen; 2) a nonsteroidal anti-inflammatory drug combined with an acid-reducing drug (proton pump inhibitor) such as TAP’s Prevacid or AstraZeneca’s Nexium; and 3) a Cox-2 inhibitor alone, such as Vioxx or Pfizer’s Celebrex.

The study marks the first time researchers have looked at the cost-effectiveness of a popular combination of two drugs and also included other factors that may affect therapy, such as aspirin use and the risk of complications such as heart attack.

According to researchers, the study also looked at the health economic consequences of heart attacks related to Cox-2 inhibitors like Vioxx. The study, completed a year before Vioxx was removed from the market, not only predicted the cardiovascular complications, but also demonstrated that a combination therapy of two other drugs may prove more cost-effective and safer than Cox-2s.

The UCLA study found that for high-risk patients, it is more cost-effective and safer to use a non-steroidal anti-inflammatory drug combined with a proton pump inhibitor, compared to using a Cox-2 inhibitor drug alone, which guidelines had traditionally recommended as a first-line therapy for this patient group. According to the study, for patients at low risk of gastrointestinal problems, a non-steroidal anti-inflammatory drug alone proved the most cost-effective.

“We found that for high-risk patients, the combination of a common anti-inflammatory drug taken with an acid-lowering drug was not only less expensive, but also safer and more effective,” said Dr Brennan Spiegel, study author and co-director of the Center for the Study of Digestive Healthcare Quality and Outcomes and assistant professor of medicine at the David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System.

“Cox-2 inhibitors were not a health economic bargain at all – especially given the added costs of more heart attacks.”