Along with Risks, COX-2 Drugs Have Many Potential Benefits

In addition to your nuanced counsel on dealing with the crescendo of dire warnings about various drugs (“The Painkiller Panic”, Dec. 23), another factor that should be considered in the precipitous withdrawal of Vioxx and the untoward panic about various pain-relievers is the vast potential of the nonsteroidal anti-inflammatory agents (NSAIDs) in the chemoprevention of cancer.

Rheumatologists (such as myself) had been aware for many years of preliminary reports of reduced rates of various cancers (notably colorectal cancer) among arthritis patients on long-term NSAIDs.

The recent Merck-sponsored study of Vioxx — ironically the study that provoked the drug’s withdrawal — is now known to have confirmed the excellent efficacy of that drug in preventing pre-malignant colon polyps. Celebrex, the other major player in the COX-2 market, has been
FDA-approved for this indication since 1999, for those susceptible to a familial form of recurrent polyps.

Now that Vioxx is gone and Celebrex under siege, what will happen to research and development of more promising new drugs for prevention of colon (and other types) of cancer? Is the slight increased risk, if any, of cardiovascular events not worth taking for many whose real risk of cancer is elevated? This decision should be made by the patient and his or her doctor, not by the FDA or “consumer advocates.”

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