Study Shows Common Painkillers Combined With Acid-Reducing Drugs More Cost-Effective, Safer for Managing Arthritis in High-Risk Patients

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Study Shows Common Painkillers Combined With Acid-Reducing Drugs More

Cost-Effective, Safer for Managing Arthritis in High-Risk Patients

Study predicted cardiovascular risk of -2 inhibitors

LOS ANGELES, April 11 /PRNewswire/ -- Amid the recent controversy

and

confusion over serious side effects from pain medications, a new UCLA

and

Veterans Affairs Greater Los Angeles Healthcare System study

demonstrates that

for arthritis sufferers at high risk for gastrointestinal problems who

traditionally may have used a drug like Vioxx, the most cost-effective

and

safest treatment is actually a common painkiller combined with an acid-

reducing drug.

Published in the April 15 issue of Arthritis Care and Research, the

clinical journal of the American College of Rheumatology, the study

used a

sophisticated economic model to develop patient scenarios and compare

costs of

the following three therapies often used for treating pain from chronic

arthritis: 1) a nonsteroidal anti-inflammatory drug alone, such as

Naproxen or

Ibuprofen; 2) a nonsteroidal anti-inflammatory drug combined with an

acid-

reducing drug (proton pump inhibitor) such as Prevacid or Nexium; and

3) a

-2 inhibitor (cyclooxygenase 2-selective inhibitor) alone, such as

Vioxx or

Celebrex.

The study marks the first time researchers have looked at the cost-

effectiveness of a popular combination of two drugs and also included

other

factors that may affect therapy, such as aspirin use and the risk of

complications such as heart attack.

According to researchers, the study also looked at the health

economic

consequences of heart attacks related to -2 inhibitors like Vioxx.

The

study, completed a year before Vioxx was removed from the market, not

only

predicted the cardiovascular complications, but also demonstrated that a

combination therapy of two other drugs may prove more cost-effective

and safer

than -2s.

" The study is one of the first to assess the most relevant

therapies for

high-risk arthritis patients, " said Dr. Brennan M.R. Spiegel, study

author and

co-director, Center for the Study of Digestive Healthcare Quality and

Outcomes

and assistant professor of medicine, Geffen School of Medicine at

UCLA

and VA Greater Los Angeles Healthcare System. " We found that for

high-risk

patients, the combination of a common anti-inflammatory drug taken with

an

acid-lowering drug was not only less expensive, but also safer and more

effective. -2 inhibitors were not a health economic bargain at all -

especially given the added costs of more heart attacks. "

More than 15 million Americans suffer from chronic arthritis,

including

osteoarthritis and rheumatoid arthritis. According to researchers, non-

steroidal anti-inflammatory drugs are the most commonly used

medications for

chronic arthritis, but can cause gastrointestinal complications such as

ulcers

and hemorrhages in high-risk patients.

The UCLA study found that for high-risk patients, it is more cost-

effective and safer to use a non-steroidal anti-inflammatory drug

combined

with a proton pump inhibitor, which is an acid-lowering drug, compared

to

using a -2 inhibitor drug alone, which guidelines had traditionally

recommended as a first-line therapy for this patient group. According

to the

study, for patients at low risk of gastrointestinal problems, a

non-steroidal

anti-inflammatory drug alone proved the most cost-effective.

Over a one-year timeframe, researchers tracked a hypothetical group

of 60-

year-old patients with chronic arthritis who require long-term

non-steroidal

anti-inflammatory drug therapy for moderate to severe arthritis pain.

Since

this is an older group, it was assumed that some patients were taking a

daily

aspirin for cardiovascular benefits.

" With an aging population that will have higher risk factors for

gastrointestinal and other health events, it's critical to assess

arthritis

therapies using additional factors that can impact treatment such as

taking

aspirin, " Spiegel said.

The model reflected probabilities of various adverse events that

could

occur, including heart attack, ulcer perforation, ulcer bleeds and

stomachaches. Medical and hospital costs for these events were factored

into

the cost analysis. Researchers used a standard measure that assesses the

outcome of health care procedures or services called the

quality-adjusted

life-year. The measurement is designed to take into account

health-related

quality of life as well as the duration of survival.

The study was funded by Tap Pharmaceutical Products Inc.,

manufacturer of

lansoprazole, which is marketed under the brand name Prevacid.

In addition to Spiegel, other researchers included Chiun-Fang Chiou

and

Dr. J. Ofman, Cerner Health Insights, Beverly Hills, Calif.

SOURCE UCLA