VIOXX Wars Good News for Large Joint Reconstruction Market
BY ROBIN R. YOUNG CFA, NOVEMBER 29, 2004
The lawyer's ads are all over the country and all over the two broadest media outlets we know - television and the internet. "Learn about Vioxx, the Vioxx recall and potential health risks!" "Are you a Vioxx Patient? Find out if you qualify for a class action suit against the drug maker." "Vioxx recalled by Merck. Heart attack? Stroke? File Now!".
Ambulance chasing raised to a depressing art form.
Vioxx is, of course, one of a handful of COX-2 inhibitors (Coxibs) that inhibit an inflammation promoting enzyme called COX-2 and thereby relieve pain associated with joint arthritis. Other currently approved Coxibs are Celebrex, Bextra and Mobicox. Vioxx was voluntarily recalled earlier this year by its manufacturer Merck.
While it is true that not all COX-2 drugs are alike, in the face of the VIOXX wars will patients be able to differentiate? How will all this adverse publicity affect attitudes toward post INSAID drug therapy? We suspect it shrinks it, but to whose benefit? Synovial fluid substitutes in knees? Large joint replacement? Cortisone shots?
All, of course, have a space on the continuum of care. Once arthritis (typically Osteoarthritis) is diagnosed, the pyramid of treatment kicks in. First line of attack are nonsteriodal anti-inflammatory drugs like aspirin, ibuprofen, naproxen or ketoprofen. These are drugs like Motrin, Advil, Aleve, Actron, Orudis, Voltaren, etc.
If NSAIDS are not effective or are of lessening effectiveness, more powerful drugs are typically added to the regimen - and those are currently the COX-2 inhibitors.
Working through the panoply of drugs, drug by drug, generally takes five to eight years. To the extent the Vioxx wars knock COX-2 inhibitors out of the continuum of care for certain patients, that should clearly shorten the amount of time doctors and patients will wait before recommending interventional treatments like synovial fluid injections or joint replacement surgery.
Since its launch in 1999 approximately 20 million patients have taken VIOXX. By 2003, pharmaceutical analysts estimated that 34% of the total OA population was taking COX-2 inhibitors. Nearly 21 million Americans suffer from osteoarthritis. Thirty four percent of that number is 7 million.
To put that in perspective, if a fourth of those patients stop taking COX-2 inhibitors and choose to move to intervention as the next step in their continuum of care - that would add 1.8 million new prospective patients for either synovial fluid or joint replacement treatment. For 2004, we estimate, there will be 1.2 million large joint replacements in the United States and Europe.
Could the VIOXX wars bump large joint replacement growth rates up for 2005 and 2006? We think that certainly possible. With every "Have you heard that Vioxx was recalled because it raised the risk of heart attack..." ad, a new clutch of patients will, we think, move to actively consider intervention. Will it be hundreds of thousands of new cases? We wouldn't rule that possibility out.
