Friday, November 24, 2006

Cox2 and the heart - the story continues

We all remember the Vioxx controversy, about the dangers of COX2 and the heart. MSD (maker of Vioxx) is still battling the many law suits being filed in the USA by the many patients who claim to have suffered heart attacks following ingestion of Vioxx for arthritis. Interestingly, MSD has another COX2 call arcoxia (etoricoxib), which they are applying for FDA approval (Arcoxia is available in Malaysia).

They had funded a study called MEDAL, comparing the CVS and Gastric side effects of 60 and 90mg of arcoxia, against 150mg of diclofenac. The result of MEDAL was presented in the just concluded AHA annual scientific meeting in Chicago. The investigators claimed they were trying to answer the question, "Does more COX2 selectivity, confer more CVS side effects?".

The study involved 34,000 patients and showed no significnat difference in CVS side effects between the two arms. Interestingly, there was also no difference in minor gastric side-effects between the two arms, although there was a difference in major gastric side-effects. In other words, MEDAL seemed to suggest that greater COX2 selectivity does not seem to confer more CVS side effects. On the side line discussion, the study seem to suggest that diclofenac (voltaren or cataflam) seems to be less CAD friendly then naproxen or ibuprufen. So the controversy continues.

The message I got from MEDAL, is that arcoxia is as safe as voltaren or cataflam. The major gastric side effects is less, while there may be some gastric irritation. The COX2 platelets effects will need more basic scientific research and animal experiments to help us understand what is happening to the platelets when they are bombarded with COX2. For one, I am personnally interested as I do take cataflam, fairly regularly for my bad left hip.

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