NICE turns down COX-2s for routine use in RA, OA in England and Wales

The National Institute for Clinical Excellence has recommended thatCOX-2-selective inhibitors should not be prescribed routinely for the treatment of patients with rheumatoid arthritis or osteoarthritis on the National Health Service in England and Wales.

The long-awaited Guidance, on Pharmacia/Pfizer's Celebrex (celecoxib), Merck & Co's Vioxx (rofecoxib), American Home Products' Lodine SR (etodolac) and Boehringer Ingelheim's Mobic (meloxicam), says that they should only be used instead of standard non-steroidal anti-inflammatory drugs in people with RA or OA who may be at high risk of developing serious gastrointestinal problems. The NICE defines high-risk patients as those aged 65 or over, those who are already taking other medicines which can cause GI problems and those who have existing GI problems.

Switching high-risk OA and RA patients to COX-2 selective inhibitors would lead to an annual incremental cost to the NHS of around L25 million ($35.4 million), it says. This estimate is based on the assumption that: - 50% of high-risk patients would be offered the drugs; - each product has an equal market share of 25%; - the proportion of patients aged over 65 is 58% for OA and 45% for RA; - the percentage of patients with previous GI events is 8%; - the average treatment duration is 180 days a year; and - the relative risk reduction is constant across different risk groups.