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Wall Street views Celebrex as the next potential blockbuster drug, because of hope that it will cause fewer ulcers, stomach bleeding and other gastrointestinal side effects commonly caused by today's most popular painkillers. Analysts predict that tens of millions of people will take cox-2 inhibitors to relieve a variety of kinds of pain. Millions of people now depend on aspirin, ibuprofen, naproxen and a host of other pills called "non-steroidal anti-inflammatory drugs," or NSAIDs. They're used for arthritis, everyday aches, recovery from surgery and a myriad of other pains. Many are available without a prescription; others come in higher-dose prescription-only strengths. But NSAIDs can cause ulcers, stomach bleeding and other gastrointestinal side effects, especially in long-term users. NSAIDs are blamed for hospitalizing 107,000 Americans every year, and killing 16,500. In 1990, scientists announced the reason. NSAIDs target an enzyme called cyclooxegenase that is responsible for much inflammation behind pain. But it turned out there are two types of this enzyme. Cox-2 was behind the inflammation, while cox-1 actually protects the stomach lining. Unfortunately, NSAIDs hit both. The theory was that if scientists could develop a more specific drug that targeted just cox-2, it would alleviate pain and inflammation while not bothering the stomach. Half a dozen companies began racing to develop a better NSAID. Searle's Celebrex, known chemically as celecoxib, is the first under FDA scrutiny. In studies of about 13,000 patients, it appeared to work almost as well as prescription-strength naproxen in patients with osteoarthritis. In rheumatoid arthritis sufferers, it appeared to work almost as well as another popular NSAID, diclofenac. But even if Celebrex isn't better than other painkillers, experts theorized it still would sell if proved safer. So Searle gave 4,700 endoscopies -- snaking a tube into patients' stomachs to see if ulcers were forming even before they experienced symptoms. Some 25 percent to 40 percent of patients taking ibuprofen or naproxen showed these mini-ulcers, vs. 5 percent to 10 percent of Celebrex patients.
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