• Hypertrophic Cardiomyopathy (HCM)
  • Eyecare
  • Urothelial Carcinoma
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Asthma
  • Atrial Fibrillation
  • COVID-19
  • Cardiovascular Diseases
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

New pain relievers may lower gastrointestinal problems but at increased cost


Everyone's familiar with nonsteroidal anti-inflammatory medications (NSAIDs). These are household names, sold in every drugstore, and consumers use them for headaches, athletic injuries, and other minor aches and pains.

Selective COX-2 Inhibitors NSAIDs target the cyclooxygenase (COX) enzymes, which synthesize prostaglandins.

COX-1 stimulates stomach mucus (which protects the lining of the stomach) while COX-2 is part of the immune response, and produces inflammation. Recently pharmaceutical manufacturers have developed a new class of medications, called selective COX-2 inhibitors, which only work against COX-2. They include:

These selective COX-2 inhibitors are just as effective against pain and inflammation as earlier NSAIDs, but they're much less likely to cause short-term GI problems. "They clearly are easier on the stomach. Whether they also prevent the rare but more serious gastrointestinal side-effects is not clear at this point," says Dr. Abramowicz. "In addition, some studies suggest that Vioxx may lead to a higher rate of heart attacks."

COX-2 inhibitors cost far more than generic NSAIDs, and they've been heavily promoted to physicians (free samples) as well as consumers (catchy jingles on TV). COX-2 usage has grown dramatically over the past few years, and annual U.S. spending on COX-2s now exceeds $6 billion, according to the Wall Street Journal.

Meanwhile, many MCOs have responded by instituting higher copayments for COX-2s compared with generic NSAIDs. One recent study looked at almost 21,000 people with either osteoarthritis or rheumatoid arthritis, enrolled in health plans with tiered formularies. On average, patients in a two-tier plan paid nearly twice as much for COX-2s compared with NSAIDs ($9.67 vs. $5.44) while patients in three-tier plans paid nearly three times as much ($15.35 vs. $5.46.)

These formularies affected member usage patterns, encouraging the use of generic NSAIDs and discouraging COX-2 selective inhibitors.

This study found that even people with serious gastrointestinal comorbidities were significantly less likely to use COX-2s if they were enrolled in a three-tiered plan.

Related Videos
Related Content
© 2023 MJH Life Sciences

All rights reserved.