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Merck & Co.'s Sept. 30 decision to pull the pain reliever Vioxx off the market has millions of patients looking for new treatments--and the choice isn't simple. Vioxx (rofecoxib) is a selective COX-2 inhibitor, a class of drugs that may be less likely to cause ulcers and gastrointestinal bleeding than older anti-inflammatory drugs.
The Merck study that prompted the drug's withdrawal involved some 2,600 people. The trial was halted prematurely because of a marked increase in heart attack and stroke among patients who took Vioxx for more than 18 months.
Previous studies by Merck and others had raised similar concerns about Vioxx's effects on the heart. The Food and Drug Administration had already required Merck to add a warning label in 2002 after a large clinical trial suggested that Vioxx might increase coronary risk. Studies of competing drugs--Celebrex and Bextra (valdecoxib), both from Pfizer--have not shown increased cardiovascular risk.
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