Thursday, June 02, 2005

Has drug advertising driven switches from Vioxx?

Did heavy marketing after the withdrawal of Vioxx lead to a spike in prescriptions — and in price — for Mobic, another anti-inflammatory drug used to treat patients with arthritis?

That intriguing question was raised today by Consumers Union, in a report on trends since Vioxx was removed from the market in September because of evidence linking it to increased risk of heart attacks and strokes.

According to the report (read it here), prescriptions for Mobic rose 136 percent in the six months following Vioxx’s withdrawal, and Mobic’s price for cash-paying retail customers climbed 9 percent, to an average of $111 or $157, depending on dose.

Mobic is not a COX-2 drug like Vioxx, Bextra or Celebrex — the only one of the three still on the market.

Instead, it’s one of the most recently developed brand-name entrants in the broader category of nonsteroidal anti-inflammatories, or NSAIDs, which includes the COX-2s as well as generic ibuprofen and naproxen, drugs that are also available over-the-counter.

Not coincidentally, that makes it one of the most expensive alternatives for patients who were being treated with Vioxx or Bextra and whose doctors want to avoid Celebrex. Prescriptions for Celebrex have fallen by more than 50 percent.

(The Food and Drug Administration says evidence of increased risks from Celebrex is inconclusive. To read the FDA’s most recent analysis of overall NSAID risks, click here. )

The Consumers Union report says the average retail price for a month’s worth of 7.5-mg tablets of Mobic rose 7 percent, from $104 to $111. For the 15-mg dose, it rose 11 percent, from $142 to $157.

Prices for some doses of prescription ibuprofen and naproxen also rose, though others stayed level or dropped. But the prices were already much lower. In March 2005, a month’s supply of prescription-strength ibuprofen ranged from $26 to $30. Generic versions of prescription-strength naproxen cost $44 to $50 a month.

So is the mass switch to Mobic a good choice by doctors, or something else?

Consumers Union says it may partly “reflect the belief among some doctors that Mobic may be easier on the stomach (the advantage touted for the COX-2s) — a belief fostered by some discussion in the professional literature but not endorsed by the FDA, many experts, or supported by definitive clinical trial data.”

But the report concludes that it’s more likely just further evidence of the distorting effect of drug advertising, both to doctors and directly to consumers.

“Doctors and consumers are unquestionably swayed by the ads and promotions for costly new medicines, even when lower-cost options that are just as effective are available,” says study author Steven Findlay.

Many doctors also make the point that rare side-effects for any medication take a while to get noticed and documented. A newer drug may indeed be safer and better. But it also may pose unexpected risks that won’t show up for a while.

So go ahead and ask your doctor about Mobic, or the latest brand-name medicine you read or hear about.

Then ask why it’s being prescribed, and whether an older, less-expensive drug might be a better choice.

9 Comments:

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Monday, November 07, 2005  
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Monday, January 30, 2006  
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