More Are Suffering Gastric Bleeding From Pain DrugsJun 11, 2004 | www.theglobeandmail.com
The popularity of a new generation of painkillers has led to a sharp increase in the number of people suffering from bleeding ulcers, according to a new study.
The research, published in today's edition of the British Medical Journal, suggests that about 2,000 additional people are being hospitalized annually with gastrointestinal bleeds in Canada as a result of taking the drugs, which are sold under the brand names Celebrex, Vioxx and Mobicox.
"This is paradoxical because these drugs have really taken off due to the perception they're safer," David Juurlink, a clinical pharmacologist at Sunnybrook and Women's College Health Sciences Centre in Toronto, said in an interview.
He stressed, however, that the research does not mean that an individual's risk is higher. In fact, there is evidence that this class of drugs, known as cox-2 inhibitors, causes fewer gastric bleeds than traditional non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.
Dr. Juurlink said the harm has come at a population level, and it is due to the massive and ever-growing number of people most of them arthritis sufferers taking the drugs.
Prior to the introduction of cox-2 inhibitors in 2000, about 14 per cent of people over the age of 65 were taking prescription NSAIDs. By 2002, that had risen to 20 per cent, and almost all of the new prescriptions for NSAIDs were for the new generation of drugs.
"We've seen a very enthusiastic embrace of these drugs on a grand scale," Dr. Juurlink said. "Patients and physicians have to realize that, even if a new drug is better, it is not free of side effects."
The new research, conducted by a team at the Institute for Clinical Evaluative Sciences (ICES), is based on an analysis of prescription and hospitalization data from 1.4 million Ontario patients over the age of 65, from 1994 through to 2002.
The rate of gastrointestinal bleeds was actually dropping until 2000, when Celebrex and Vioxx were introduced with much fanfare. Since then, the number of seniors hospitalized with gastrointestinal bleeds has edged up to 17 per 100,000 from 15 per 100,000. While that increase may seem modest, it is significant because of the large numbers of people taking the drugs. About 15,000 seniors a year are hospitalized due to bleeding ulcers that result from prescription drug use.
Dr. Juurlink said this research should not prompt individuals to stop taking prescribed painkillers. "This study documents one aspect of harm, but it cannot quantify benefit. People may very well have a better quality of life because of these drugs," he said.
There were 7.7 million prescriptions for cox-2 inhibitors in Canada last year, with a total value of $475-million, according to IMS Health Canada, a private company that tracks prescription drug use. There were 16 million prescriptions for other NSAIDs, with sales totalling $305-million.
About four million Canadians suffer from arthritis.
Research published last month by ICES scientists showed that people who are taking NSAIDs not only have more bleeding ulcers, they are at greater risk of developing congestive heart failure.
The new study found that taking Vioxx increased the risk of hospitalization for heart failure by 80 per cent within one year of prescription. Taking a traditional NSAID increased the risk by about 10 per cent.