Intended for healthcare professionals


Lessons from the withdrawal of rofecoxib

BMJ 2004; 329 doi: (Published 14 October 2004) Cite this as: BMJ 2004;329:867
  1. Paul A Dieppe, director (,
  2. Shah Ebrahim, head of department,
  3. Richard M Martin, senior lecturer in epidemology and public health,
  4. Peter Jüni, senior research fellow in clinical epidemiology
  1. MRC Health Services Research Collaboration, University of Bristol, Bristol BS8 2PR
  2. Department of Social Medicine, University of Bristol
  3. Departments of Social and Preventive Medicine and Rheumatology, University of Berne, CH-3012 Berne, Switzerland

    Patients would be safer if drug companies disclosed adverse events before licensing

    The history of the development and marketing of non-steroidal anti-inflammatory drugs is both fascinating and frightening. It offers a strange combination of stunning commercial successes and dramatic calamities, the latest concerning the recently withdrawn drug rofecoxib (Vioxx).1

    In the 1960s research showed that salicylates were good for pain relief in rheumatoid arthritis, but as with steroids, their use was limited by toxicity.2 So the major pharmaceutical companies developed non-salicylate, non-steroidal anti-inflammatory drugs (NSAIDs). Over the subsequent 40 years we have seen a procession of new agents come and go, each one being heralded as either more efficacious or less toxic than its competitors. As new NSAIDs appeared, the indications steadily broadened from inflammatory diseases to almost any painful condition. Each time a new drug was launched the market expanded, resulting in annual estimated sales of more than $20bn (£11.1bn; €16.1bn) worldwide.2

    The first big problem with a new NSAID occurred in the 1980s with benoxaprofen (Opren).3 This drug, developed by Eli Lilly, was marketed on the basis of a unique mode of action. But it soon became clear that its use was associated also with novel adverse events, including photosensitivity and hepatotoxicity. …

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