SALES of the world’s bestselling group of painkillers have collapsed after one of their type was linked to heart problems.

Last June 70 per cent of arthritis patients prescribed a painkiller by their GP for the first time received Cox-2 inhibitors, a class of drugs of which the two leaders were Vioxx and Celebrex. By February, after Vioxx was withdrawn by its manufacturer, Merck, this had fallen to 7 per cent, in spite of evidence that the Cox-2 inhibitors remaining on the market were safer than alternative, older drugs.

Overall, sales of Cox-2 inhibitors fell by 75 per cent between September 2004 and February 2005, according to Compufile, a company that monitors GP prescribing. Prescriptions for Celebrex, the Pfizer drug that is now the market leader, were down by more than 60 per cent, even though there was no strong evidence of problems.

Arthritis Care, a charity, said yesterday that it had received hundreds of inquiries from worried people who have been taken off Cox-2s. Some have been switched to older, non-steroidal anti-inflammatory drugs (NSAIDs), which have a well-founded reputation for causing ulcers and bleeding from the stomach.

“Many do not want to be prescribed NSAIDs, and for some, NSAIDs are not a safe alternative because of the risk of gastrointestinal bleeds,” it said. “As a result many are confused and unhappy because their experience suggests that Cox-2s were working well for them by reducing their pain and increasing their mobility.”

Cox-2 inhibitors were developed to be more selective, and therefore safer, than NSAIDs. The evidence is that they are significantly less likely to cause ulcers, a major cause of hospital admission and death among NSAID users.

The trend away from Cox-2 inhibitors is likely to accelerate after last week’s suspension of another one, Bextra, which is also made by Pfizer. The suspension, to which Pfizer objected, was as a result of evidence that Bextra could cause skin problems, though it has also been linked to a higher rate of heart problems.

Sir Alasdair Breckenridge, chairman of the Medicines and Healthcare products Regulatory Agency, said yesterday: “There is a history of good drugs disappearing. Even though regulators try to put out as measured a message as they can, people tend to extrapolate from it.

“In this case, we have also seen a drip, drip, drip of publicity. Of course this is not good news for patients. We believed that Cox-2 inhibitors were a very significant therapeutic advance.”

He said that any extra heart risks that the drugs might carry were much lower than those of smoking, having a poor diet or being overweight. “The risks have to be looked at in this context,” he said.

The European Medicines Evaluation Agency (EMEA) has been reviewing all Cox-2 inhibitors. Its findings are expected to be published in the next week or so.

Arthritis Care said it believed that GPs had lost confidence in Cox-2s and as a result were being even more cautious than stricter guidance required.

“We believe this is partly due to the time being taken by the EMEA to conclude its investigation,” a spokesman said.

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