ASK DR. BAUGHAN                                             February 26, 1999

CELEBRITY CELEBREX

“The hottest new drug since Viagra!” the newscaster trumpeted.  “The most prescriptions in the first week of release of any drug since Viagra.”  Cut to a clip of a pharmacist saying, “We ran out the first day.  We can’t keep it in stock fast enough.”  Who is this new celebrity in the world of medicine?  Is it a bright new star that will enrich our lives for decades, or a 15-minute wonder in our celebrity-of-the-week culture?  The drug in question is Celebrex, a new arthritis medicine.

Celebrex is the first medicine in a family of arthritis medicines that will introduce the phrase COX-2 into the popular consciousness.  COX-2 refers to cyclo-oxygenase inhibition.  Can you say that three times, and why should you?  The curious thing about COX-2 medicines (more are in development) is not that they treat arthritis better.  They are equally potent to naproxen (Aleve or Naprosyn) or diclofenac (Voltaren or Cataflam) in relieving joint pain and inflammation.  The major difference to them is that they are kinder and gentler to stomachs.

The most common reason people cannot tolerate arthritis medicines is that they upset stomachs, cause ulcers and can cause life-threatening bleeding ulcers.  The main attention in arthritis medicines in development is to decrease the risk of bleeding ulcers.  There are several strategies.  We have had a medicine (Cytotec) for almost ten years whose only purpose is to protect the stomach from potential damage from arthritis medicines.  It has not exactly been the darling of the stock market for several reasons.  It is as expensive as many arthritis medicines, and most folks balk at paying a bunch of money for a drug that does not directly relieve their pain.  It also commonly causes diarrhea in full therapeutic doses.  Recently manufacturers have tried to disguise it by combining it with an arthritis drug in the same pill, Arthrotec.  It is sort of like when Dolly Parton toured with Kenny Rogers, two veteran performers in a new act, . . . kind of.  (I leave it to your imagination to decide who relieves pain and who causes diarrhea.)

The studies so far on Celebrex show less ulcer formation and bleeding, but it is still a risk.  The comparisons for ulcers are Celebrex 7%, naproxen 35%, ibuprofen 24%, and diclofenac 15% doing endoscopies 4 times over 12 weeks.  Other side effects include upset stomach (8.8%), headache (15.8%), and ankle swelling (2.1%) - all similar to other arthritis medicines.

You should not take Celebrex if you have an allergic reaction to sulfa antibiotics (Septra, Bactrim, Gantrisin) or have had an allergic reaction or asthmatic reaction to other arthritis medicines.  It seems safe to take if you need to take low-dose aspirin or Coumadin for other medical problems.  It is broken down in the liver, so if you have liver problems, adjustments in the dose should be made.  It may interact with ACE inhibitor blood pressure medicines (Monopril, Accupril, etc.) or diuretics like furosemide (Lasix).

It does not come cheap.  A month’s worth of the usual dose of 200mg once a day will cost ____.  So do not expect managed care companies to embrace this as the first choice drug for arthritis.  It may be reserved for those with a history of ulcers or internal bleeding, or to people who have tried several other pills first and could not tolerate them.

My assessment is that COX-2 arthritis medicines are arthritis medicines with air-bags.  Initially air-bags were expensive luxury items on Volvos and Mercedes.  Now they are standard safety features.  When other COX-2 medicines come along, the price may come down, and for safety reasons they may gradually replace the current arthritis medicines.  But air bags do not prevent all injuries, and they do not make the car run better.