Microsoft word - vioxx response.doc
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Dear ScriptGuideRX Client: As you may be aware, Merck & Co., the manufacturer of Vioxx, announced they were
voluntarily withdrawing this pain reliever from the market worldwide. The decision to withdraw
the product is effective immediately. Vioxx is in a therapeutic class of drugs referred to as
Cox I ’s; alternative medications in the Cox I class are Celebrex (celecoxib) and Bextra
(valdecoxib). ScriptGuideRX/4D has taken the folowing actions in response to the worldwide withdrawal of
Effective September 30, 2004, our processing system wil reject any
additional Vioxx scripts from processing. If your plan requires a prior authorization for Vioxx, existing active prior
authorizations wil be changed to alow another Cox I to process, without the
members or physicians needing to obtain approval for the change of Cox
For your convenience we have attached the Vioxx (rofecoxib) Questions and Answers
from the FDA web site; http://www.fda.gov/cder/drug/infopage/vioxx/vioxxQA.htm .
Additional information regarding this product withdrawal is available on the Internet at
www.merck.com ; http://www.fda.gov/cder/infropage/vioxx/PHA vioxx.htm. If you have any questions, please contact me by phone or e-mail. Sincerely, Lindsay Roth Vice President
Vioxx (rofecoxib) Questions and Answers
1. What action did Merck take today?
Merck announced a voluntary worldwide withdrawal of Vioxx (rofecoxib). 2. What is Vioxx?
Vioxx is a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). Vioxx is also related
to the nonselective NSAIDs, such as ibuprofen and naproxen. Vioxx is a prescription
medicine used to relieve signs and symptoms of arthritis, acute pain in adults, and painful
menstrual cycles. 3. Did FDA require this action?
No, Merck made this decision independent of input from FDA. The Agency has not had an
opportunity to review the data from the study that was stopped in the depth that Merck has,
but agrees with the company that there appear to be significant safety concerns for patients,
particularly those taking the drug chronical y. FDA plans to work closely with Merck to coordinate the withdrawal of this product from the
US market. 4. What action did FDA take today?
FDA issued a public health advisory concerning the use of Vioxx. This advisory is based
on Merck & Co., Inc. voluntarily withdrawing Vioxx from the market due to safety concerns. 5. What should I do if I am currently taking Vioxx?
The risk that an individual patient wil suf er a heart attack or stroke related to Vioxx is very
smal . We encourage people taking Vioxx to contact their physician to discuss
discontinuing use of Vioxx and alternative treatments. Any decision about which drug
product to take to treat your symptoms should be made in consultation with your physician
based on an assessment of your specific treatment needs. 6. What are the likely long-term health effects, if any, of taking this product?
The new study shows that Vioxx may cause an increased risk in cardiovascular events such
as heart attack and strokes during chronic use. 7. What evidence supports the Public Health Advisory?
Merck’s decision to withdraw Vioxx from the market is based on new data from a trial cal ed
the APPROVe [ Adenomatous Polyp Prevention on VIOXX] trial. In the APPROVe trial,
Vioxx was compared to placebo (sugar-pil ). The purpose of the trial was to see if Vioxx
25 mg was effective in preventing the recurrence of colon polyps. This trial was stopped
early because there was an increased risk for serious cardiovascular events, such as heart
attacks and strokes, first observed after 18 months of continuous treatment with Vioxx
8. Why wasn’t the APPROVe trial stopped earlier?
The APPROVe trial began enrol ment in 2000. The trial was being monitored by an
independent data safety monitoring board (DSMB). It was not stopped earlier because the
results for the first 18 months of the trial did not show any increased risk of confirmed
cardiovascular events on Vioxx. 9. What did FDA know about the risk of heart attack and stroke when it approved Vioxx?
FDA original y approved Vioxx in May 1999. The original safety database included
approximately 5000 patients on Vioxx and did not show an increased risk of heart attack
or stroke. A later study, VIGOR (VIOXX GI Outcomes Research), was primarily designed
to look at the effects of Vioxx on side effects such as stomach ulcers and bleeding and was
submitted to the FDA in June 2000. The study showed that patients taking Vioxx had fewer
stomach ulcers and bleeding than patients taking naproxen, another NSAID, however, the
study also showed a greater number of heart at acks in patients taking Vioxx. The VIGOR
study was discussed at a February 2001 Arthritis Advisory Committee and the new safety
information from this study was added to the labeling for Vioxx in April 2002. Merck then
began to conduct longer-term trials to obtain more data on the risk for heart at ack and
stroke with chronic use of Vioxx. 10. Is FDA’s expedited review process putting riskier drugs on the market?
No. Vioxx received a six-month priority review because the drug potential y provided a
significant therapeutic advantage over existing approved drugs due to fewer gastrointestinal
side effects, including bleeding. A product undergoing a priority review is held to the
same rigorous standards for safety, efficacy, and quality that FDA expects from al drugs
submit ed for approval. 11. What other drugs are similar to Vioxx?
Vioxx is a COX-2 selective, nonsteroidal anti-inflammatory drug (NSAID). Other COX-2
selective NSAIDs on the market at this time are Celebrex (celecoxib) and Bextra
(valdecoxib). Vioxx is also related to the nonselective NSAIDs, such as ibuprofen and
naproxen. You should consult your physician to determine which treatment is right for you. 12. Does today’s action suggest that other drugs in the same class are dangerous?
The results of clinical studies with one drug in a given class do not necessarily apply to other
drugs in the same class. Al of the NSAIDs have risks when taken chronical y, especial y
of gastrointestinal (stomach) bleeding, but also liver and kidney toxicity. Patients using these
drugs for a long period of time (longer than two weeks) should be under the care of a
physician. 13. Will Vioxx be recalled?
FDA did not request a recal of Vioxx. This product is being voluntarily withdrawn from the
market by Merck. 14. Can my pharmacist continue to fill my prescription for Vioxx?
No, Merck is initiating a market withdrawal in the United States to the pharmacy level. This
means Vioxx wil no longer be available at pharmacies.
15. How can I report a serious side effect with Vioxx to FDA?
FDA encourages anyone aware of a serious adverse reaction to make a MedWatch
report. You can report an adverse event in two ways:
Visit www.fda.gov/medwatch and click on "How to Report"
Cal 1-800-FDA-1088 16. Where can I get more information?
You can obtain more information from Merck at:
To find out more about Vioxx from FDA:
Visit our Drug Information web page at: www.fda.gov/cder
Cal Drug Information at: 888-INFO-FDA (888-463-6332)
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