Doctors writing in a prominent medical journal recommended that physicians stop prescribing Pfizer Inc.'s Bextra painkiller, just as a large study found the drugmaker's sister drug, Celebrex, doubled risk of heart attacks.

Both drugs are members of the so-called COX-2 inhibitor class of painkillers, which recently gained notoriety when Merck Inc. withdrew Vioxx in September after a study found it doubled the risk of heart attack and stroke.

A letter by doctors published in The New England Journal of Medicine's Dec. 23 edition said in light of Vioxx and negative signs on Bextra, Bextra should be avoided.

"To protect the safety of the public, we write to recommend that clinicians stop prescribing valdecoxib (Bextra), except in extraordinary circumstances," editorial writers at The New England Journal of Medicine wrote in an issue dated Dec. 23 but released early.

Pfizer said a government-sponsored trial of Celebrex was halted after patients taking the medicine had more than twice as many heart attacks as patients taking a placebo.

Pfizer has aggressively defended Bextra and Celebrex since Vioxx's withdrawal and questions about safety arose. Officials at Pfizer said they had not seen the medical journal letter and could not comment.

Friday's developments will rekindle debate over the merits and safety of the entire class of painkiller drugs, doctors said.

The authors of The New England Journal of Medicine letter are doctors at the Vanderbilt University School of Medicine.

They said they made the recommendation in light of the long lag time between when evidence emerged on Vioxx and its withdrawal, coupled with two negative studies suggesting Bextra boosts heart problems in bypass patients by a factor of three.

Reference Source 89
December 17, 2004

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