Coxibs - Past Problems...Future Potential
LeadDiscovery
October 1, 2006 62 Pages - SKU: LD1354383
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Spanning the field of pain, inflammation and oncology, as well as more recently for unwanted reasons, cardiovascular disease the cyclooxygenase-2 (COX-2 or Coxibs) have sat in the spot light for almost a decade now.
The first Coxib, Celebrex (celecoxib), arrived on the market in 1998 rapidly becoming a blockbuster soon to be followed by another equally successful drug from the same class, Vioxx (rofecoxib). Soon after however, cardiovascular adverse effects were found to be associated with Vioxx leading to its withdrawal and sparking the start of a turbulent period affecting not only Vioxx, but the Coxib class as a whole and more generally all NSAIDs.
LeadDiscovery’s report Coxibs - Past Problems…Future Potential was written to provide all in the drug development sector a detailed look at the events leading up to the withdrawal of Vioxx, the status of the Coxib class 2 years on and its future potential.
Far from slipping into the pharmaceutical backwater this class continues to provide blockbuster revenues for Pfizer and potential for others. This report is key to companies considering reentry into the COX-2 arena and those developing other analgesics that could canabilize the coxib market. The report is also written with the aim of guiding companies investing in chemoprevention and Alzheimer’s disease, indications that have been investigated as target for the Coxibs.
Against a backdrop of litigations brought against Merck & Co and new regulatory guidelines for the coxibs, Pfizer’s Celebrex generated $1.7 billion in revenue last year and continues to win approval for new indications, the most recent being ankylosing spondylitis. The continued potential of the Coxibs is evidenced by clear activity of this class in the prevention of certain pre-cancerous growths and uncertainty over the cardiovascular safety of NSAIDs. Most recently data has emerged offering a possible explanation behind the cardiovascular activity of the Coxibs offering the potential to rationally design new agents with improved therapeutic margins.
Coxibs - Past Problems...Future Potential is designed to help readers address questions such as:
- What trials have been conducted and what do they mean?
- How does the use of an NSAID plus a gastroprotective agent compare to that of a Coxib with respect to gastrointestinal safety?
- What is the cardiovascular risk attached to the Coxibs - is the risk simply a reflection of the comparator used in pivotal trials?
- Do the Coxibs still offer an advantage over NSAIDs
- What is the mechanism of increased cardiovascular events, what is their time frame and how can they be minimized?
- What is the regulatory view on the Coxib class and NSAIDs?
- Is the development of Coxibs for the prevention/treatment of cancer or Alzheimer’s disease justifiable?
- What is the current status of approved and pipeline Coxibs?
- How has the Coxib market changed since 2003?
- Should companies attempt to develop new Coxibs?
- If so what should be the developmental goals and what should be the indications?
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- The biology of the cyclooxygenase pathway
- Inflammatory response to prostaglandins
- Immunomodulatory effects of prostaglandins
- Hyperalgesic effects of prostaglandins
- Pyretic effects of prostaglandins
- Prostaglandin-mediated mucosal protection
- Cardiovascular effects of the prostaglandins
- Thrombotic effects of the prostaglandins
- Angiogenic activity of the prostaglandins
- Airway effects of the prostaglandins
- An introduction to COX inhibitors
- The mechanism of action of aspirin and its therapeutic effects
- Other early COX inhibitors
- Complications associated with NSAIDs
- GI Toxicity
- Misoprotol as a strategy for reducing gastrointestinal injury with NSAIDs
- PPI use a strategy for reducing gastrointestinal injury with NSAIDs
- The rational for Coxib development
- The identification of COX-2
- Expression of COX-1 and COX-2
- Improved gastrointestinal safety as the rational for Coxib development
- A Role for COX-2 in cancer
- A Role for COX-2 in Alzheimer’s disease
- The existence of COX-3-an under-investigated molecular target for novel analgesics
- Clinical data on approved and late stage Coxibs
- Serendipitous selective COX-2 inhibitors
- Nimesulide
- Etodolac
- Meloxicam
- Rationally designed COX-2 inhibitors
- First generation Coxibs
- Rofecoxib (Vioxx; Merck)
- Background data
- Reduced gastrointestinal adverse effects of Vioxx
- Pivotal trials
- VIGOR (Vioxx Gastrointestinal Outcomes Research) study
- Comment on VIGOR
- APPROVe (Adenomatous Polyp Prevention on Vioxx) trial
- Celecoxib (Celebrex; Pfizer)
- Background data
- Pivotal trials
- CLASS (Celecoxib Long-Term Arthritis Safety Study) trial
- SUCCESS-I
- Second generation Coxibs
- Valdecoxib (Bextra; Pfizer )
- Background data
- Dynastat (parecoxib; Pfizer)
- Background data
- Arcoxia (etoricoxib; Merck)
- Background data
- Pivotal trials
- MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-Term) study
- Prexige (lumiracoxib; Novartis)
- Background data
- TARGET (Therapeutic Arthritis Research and Gastrointestinal Event Trial)
- Differentiating the risk of COX-2 inhibitor family members
- Risk of skin rash
- Cardiovascular risk
- Cardiovascular risk of the Coxibs - mechanistic insight
- Hypertension Risk
- Effect of COX-2 inhibition on atherosclerosis
- Effect of COX-2 inhibitors on thrombosis
- Cardiac arrhythmias
- Structural rather than class related causes of differential cardiovascular effects
- Clinical data supporting use of Coxibs for new indications
- Cancer
- Colorectal cancer
- Adenoma Prevention with Celecoxib (APC) trial
- Prevention of Spontaneous Adenomatous Polyps (PreSAP) trial
- Adenomatous Polyp Prevention on Vioxx (APPROVe)
- Optimizing colorectal chemoprevention-Extension to chemotherapy?
- Cervical dysplasia
- Breast cancer
- Lung cancer
- Alzheimer's disease
- Safety recommendations following reintroduction of COX-2
- Regulatory stand point
- Current status of approved Coxibs, future events & pipeline agents
- Merck Franchise
- Vioxx
- Arcoxia
- Pfizer Franchise
- Celebrex
- Bextra
- Dynastat
- Novartis Franchise
- Prexige
- Other Coxibs in clinical stage development
- Knock-on effect of Vioxx's withdrawal
- Sales performance of other COX-2 inhibitors
- Immediate effects of Vioxx withdrawal
- Historical and current sales figures of Coxibs
- Historical and current sales figures of NSAIDs
- Emerging alternatives to COX-2 inhibitors
- Phospholipase A2 inhibitors
- Lipoxygenase inhibitors
- Variations on NSAIDs
- Focus on Nitronaproxen (NicOx)
- DMARDs
- DMOARDs
- Conclusions & Recommendation on future use of Coxibs
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