Vioxx, Opioids, and Falls

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Here's a review of results from pulling Vioxx off the markets and it's narcotic replacements leading to increased falls in elders . . . . Visit us online at www.MedPageToday.com A | A | A | A ACR: A Tale of Vioxx, Opioids, and Falls By Gever, Senior Editor, MedPage TodayNovember 12, 2010 MedPage Today Action Points Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Explain that a large health system database showed that treatment of osteoarthritis in the elderly using narcotics only increased markedly after rofecoxib was removed from the market. Explain that the number of falls and fractures also increased during this same period, exclusively among those prescribed narcotics. ReviewATLANTA -- Pulling rofecoxib (Vioxx) from the market may not have done any favors for elderly patients with osteoarthritis, a researcher suggested here.Among some 11,000 osteoarthritis patients listed in a major health system database from 2001 to 2009, the number of opioid prescriptions and the rate of falls and fractures skyrocketed starting in 2005, the year after rofecoxib was removed from the market, said Bruce Cronstein, MD, of New York University in New York City.All the increase in falls occurred in patients receiving narcotic painkillers, Cronstein said at a late-breaking poster presentation here at the American College of Rheumatology meeting.He suggested that clinicians should consider other pain treatments in elderly osteoarthritis patients, such as NSAIDs combined with proton pump inhibitors, before resorting to opioids.In the study, Cronstein and colleagues obtained records on all patients 65 and older with a diagnosis of osteoarthritis in the Geisinger Health System, which covers some two million people in central Pennsylvania.They analyzed year-by-year data on prescriptions of COX-2 inhibitors such as rofecoxib, narcotics, and conventional NSAIDs, as well as records of falls and fractures.Narcotic-only prescription rates were already rising before rofecoxib was taken off the market in September 2004 -- from about 8% of patients in 2001 to 20% in 2004, but the practice accelerated afterward, hitting 40% by 2009.By 2004, about 10% of patients were taking COX-2 inhibitors, but that figure fell to 2% starting in 2005, even though celecoxib (Celebrex) remained on the market.Standard NSAIDs also became less popular, Cronstein reported.Over the same 2001 to 2009 time period, the percentage of patients experiencing falls and fractures rose considerably, from less than 1% to about 4%.The year-by-year data indicated that the surge in falls and fractures was concentrated in patients who were receiving prescriptions for narcotics. "They accounted for the entire increase," Cronstein said.He said the COX-2 inhibitors had been an attractive option for elderly patients because they are more susceptible to the gastrointestinal side effects of NSAIDs and also to the central nervous system effects of narcotics. When the COX-2s were removed, opioids apparently were seen as the next best thing, he said, although he acknowledged that that is not the only factor."There's been a general trend across the country in the past 10 or 15 years to promote the prescription of narcotic analgesics for the treatment of both acute and chronic pain," Cronstein told MedPage Today.He said a belief has spread that patients don't experience cognitive or motor impairments from current opioid drugs, but the study findings suggest otherwise.Clinicians "probably shouldn't be using so much in the way of narcotic analgesics," he said, though he added that the alternatives have their own problems.The study had no commercial funding.Cronstein reported relationships with Amgen, Bristol-Myers Squibb, Canfite, Cypress, King, Cephalon, Endocyte, OSI, Regeneron, Roche, Savient, Takeda, and URL Pharma.Primary source: American College of RheumatologySource reference: Rolita L, et al "Unintended consequences; increased prescription of narcotic analgesics for OA in the elderly is associated with increased falls and fractures in the post-Vioxx era" ACR 2010; Abstract L14.Disclaimer The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. 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