STANFORD, Calif. - When Vioxx began being sold in 1999, it was touted for relieving pain without causing the gastritis and ulcers that some people developed from taking ibuprofen, naproxen and other painkillers known as non-selective non-steroidal anti-inflammatory drugs, or NSAIDs.

But over the next four years, it turned out that Vioxx was adopted way beyond that market niche: millions of people who had little risk of gastrointestinal bleeding ended up getting prescriptions for Vioxx, Celebrex and other medicines in their class, known as COX-2 inhibitors.

The overuse of these drugs is documented in a study published in the Jan. 25 issue of the Archives of Internal Medicine by Randall Stafford, MD, PhD, associate professor of medicine at the Stanford University School of Medicine, and University of Chicago researchers G. Caleb Alexander, MD, and Carolanne Dai. Their findings reveal that 63 percent of the growth in COX-2 use from 1999 through 2002 occurred in patients with minimal risk of suffering gastrointestinal bleeding from NSAIDs.

Stafford said the problems associated with COX-2 inhibitors should serve as a cautionary tale about the growing trend of turning custom-fit medications into one-size-fits-all remedies. The researchers attribute the overuse of the drugs to several non-clinical factors-including heavy marketing and the tendency of patients and physicians to equate "newer" with "better" medicines-that have spurred sales of other drugs as well.

"This phenomenon is not limited to COX-2 inhibitors," Stafford said, noting that it also happened with drugs for hypertension, diabetes and some infections. "There are a number of instances where use has expanded beyond the narrow clinical situations in which the drugs are most effective and cost-effective."

The medical profession has a term for expanding the use of a drug beyond its inten
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Contact: Susan Ipaktchian
650-725-5375
Stanford University Medical Center
21-Jan-2005