Fighting Arthritis Pain

Two U.S. firms introduce promising, once-a-day drugs

The search for relief from arthritis is as old as man, going back, in fact, to man's Neanderthal predecessors. Today, arthritis inflames the joints of 10% of the world's population, including one out of seven Americans. There are dozens of helpful drugs on the market, as well as countless quack remedies ranging from copper bracelets to snake venom. Aspirin, however, remains the treatment of choice. The trouble is that in order to suppress inflammation as well as pain, aspirin often must be taken in megadoses--15 to 20 tablets a day. At such levels, it can cause stomach distress, ulcers and hemorrhaging. And so, spurred by a market that grows by a million persons a year in the U.S. alone, pharmacologists keep searching for a better drug. Within the past month, two companies claim to have found it: Oraflex (chemical name: benoxaprofen), introduced last week by Eli Lilly & Co., and Feldene (piroxicam), unveiled several weeks ago by Pfizer Inc. Both drugs have been successfully marketed abroad.

The new drugs are anti-inflammatory agents like aspirin but remain in the bloodstream six times as long. Thus they are effective as once-a-day doses. They are also less apt to irritate the digestive tract. According to Lilly, Oraflex causes 50% fewer gastrointestinal side effects than aspirin. There remains a drawback. In clinical trials, Oraflex caused sun sensitivity leading to an itchy rash in about 20% of patients. This can be prevented by applying sunscreen lotions or even by getting a protective suntan before using the drug.

Feldene and Oraflex both work like aspirin in that they block the release of certain prostaglandins, hormone-like substances that contribute to pain and swelling. Perhaps in an effort to distinguish its product from Pfizer's, Lilly makes the additional claim that Oraflex may actually slow the progression of the disease. The claim is based on preliminary research showing that Oraflex inhibits the migration of macrophages, a type of white blood cell, to the inflamed joint. Macrophages ordinarily defend the body against foreign invaders, but in some forms of arthritis they appear to attack the body, destroying bone and cartilage.

To prove that Oraflex does retard this destructive process, Lilly has embarked upon a three year, 1,600-patient study. A number of researchers doubt, however, that Oraflex is unique in its action on macrophages. Pfizer Medical Director Dr. John Jefferis maintains, "Feldene does everything benoxaprofen does." Says Dr. Frederic McDuffie of the Arthritis Foundation: "I would predict that whatever effect you could get with benoxaprofen you also could get with aspirin, if you gave enough of it."

Yet for some patients, the new drugs have already succeeded where aspirin failed or proved too irritating to tolerate. Jo Ann Schwartz, 50, of Topsfield, Mass., was taking 18 Bufferins daily and still finding it too painful to walk upstairs. She became a subject in an Oraflex study, and "within 30 days, I could start doing things again," she says. She is now back on her bicycle and kicking up her heels in the pool. But Schwartz was one of the lucky ones. About 20% of arthritis sufferers are not helped by the new drugs. For them, the search continues.

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