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Gastroenterology and Health

Cox-2, Cox-1, Stomach lining

Prexige A New Painkiller For Arthritis Pain

By Dr. W. Gifford Jones

January 13, 2007

What did 34,000 patients share? They all suffered from a variety of arthritic pain. They also agreed to participate in a clinical trial to evaluate whether a new non-steroidal anti-inflammatory drug (NSAID) was safe for doctors to prescribe. Now, after the largest study ever conducted on a non-steroidal anti-inflammatory drug, Prexige, is available to treat the pain and inflammation of osteoarthritis (OA).

Today over 22 million North Americans suffer this debilitating problem, the wear and tear type of arthritis, where bones eventually grind on bones. Some people have to give up a favourite sport, gardening, taking a daily walk, find it difficult to navigate the stairs or even open a bottle.

Doctors have had trouble for years trying to treat this common disease. The older NSAIDS such as ibuprofen and naproxen were not always kind to the stomach.

These drugs attack an enzyme called COX-2 which causes inflammation. But they also affect an enzyme called COX-1 that normally protects the stomach's lining. This may result in sudden unexpected bleeding from a gastrointestinal ulcer. Most people are unaware that 2,000 Canadians and 16,000 in the U.S. die every year from this complication. A huge price to pain for pain relief.

A study in the United Kingdom used an optical instrument to examine the stomachs of patients after using the older NSAIDs. The results were shocking. Doctors reported that after two months use one in five patients had a stomach ulcer without symptoms, one in 70 a painful ulcer, one in 150 a bleeding ulcer and one in 1200 died from a gastric hemorrhage.

In a Danish study researchers tracked 207,000 people for 19 years who had been on the older NSAIDs to determine the extent of intestinal bleeding. It showed that these drugs increased the risk of bleeding five times. For those over 75 years of age the risk was 27 times greater. And in the U.S. 107,000 people are hospitalized every year due to intestinal side-effects of NSAIDs.

Researchers did the obvious thing. They designed new drugs such as Celebrex, and Vioxx. These medications were more specific primarily attack the inflammatory enzyme Cox-2, but protecting the stomach's lining by helping to preserve COX 1. But when Vioxx was removed from the list of painkillers due to an increased risk of cardiovascular disease doctors were left with just Celebrex.

Having just one effective drug is always a poor option for doctors and patients. As Dr. Bensen, a prominent rheumatologist at McMaster University in Hamilton, says, The more options we have, the easier it will be for us to prescribe the right medicine, to the right patient, at the right dosage, for the right duration.

So the arrival of Prexige is an important milestone in fighting the pain and inflammation of osteoarthritis. Particularly, since studies show that patients with osteoarthritis using Prexige were 79 percent less likely to develop gastrointestinal complications than those using the older NSAIDs ibuprofen and naproxen. And none of the Prexige patients developed intestinal erosions.

Moreover, patients using Prexige did not experience any increase in heart attack or stroke. And Prexige had 80 percent less impact on blood pressure than patients taking the older NSAIDs. And it's a convenient once daily dosing of 100 milligrams.

We all know the terrible agony suffered by some cancer patients. But pain is pain and we tend to underestimate the day after day agony of those afflicted with arthritis.

We also tend to underestimate the effect of osteoarthritis on the psyche. The many E-mails and letters I receive from readers often remark on the depression and hopelessness associated with this disease.

OA is a major problem for this country. This disease affects one in every 10 people accounting for 50 per cent of all chronic conditions over the age of 65. And in Canada the annual economic cost is 4.4 billion dollars.

Prexige will save some of these healthcare dollars. Fewer patients will need to stop the medication due to side-effects. It will also result in decreased visits to doctors for upset stomachs. Equally important, less expensive hospitalizations from either bleeding ulcers or ones that perforate the stomach.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod