Well, we're finally coming to the end of the FDA's COX-2 marathon. My predictions will be overtaken by reality soon, but I know that a lot of people are following this, so I'll take a crack at it:
I don't think we're going to see any drugs pulled outright from the US market, but if there is one, it'll probably be Bextra. Assuming it stays on the market, I think that it and Celebrex will pick up additional warnings, along with guidance to prescribe it only to patients who can't tolerate the more traditional anti-inflammatories. The FDA has been trying to do that already, and I think we'll see it emphasized again.
And if those two drugs and Vioxx all suffer from the same risks, which I think is likely the case, then why shouldn't Vioxx come back on the market, as Merck's Peter Kim said the other day? He has a point. After all, the recall was voluntary, not FDA-mandated, and as far as I know, there's nothing keeping Merck from bringing the drug back.
As for Merck's follow-up COX-2 (Arcoxia) and Novartis's Prexige, neither of which is available in the US yet, I think that the FDA will want to see major cardiovascular data. Perhaps they'll let them through, eventually, with the same set of warnings and guidelines I expect to see attached to the current drugs. But if the companies want better terms, they're going to have to show some evidence why they should have them.
So we might end up, after all the mud is washed off the walls, with more COX-2 drugs on the market than we have now. Odd, eh? They'll be fighting inside what's supposed to be (and probably will be, in fact) a smaller market, though. The real financial damage has already been done, because this class of drugs will never be what it was a few months ago. Makes you wonder if a big launch of Arcoxia, et al., is even going to be worth the effort.
Which brings up one more point: in the above, I mentioned prescribing COX-2 drugs "only to patients who can't tolerate the more traditional anti-inflammatories", and I'll bet that many people read that and added ". . .just like they should have all along." And it's true that we probably wouldn't have even seen the cardiovascular side effects in that smaller patient population (nor would we have been bombarded with COX-2 ads, for that matter.)
But that's what companies do - try to broaden their market as much as possible. I think that Merck and Pfizer overdid it in the pain market, true. But keep in mind that some of the bad news about these drugs came from trials of them against other possible targets (colon cancer, for example.) The only way we're going to find out if they work in these indications is to run those trials, and finding bad news instead of good is the risk that we in the industry take. I think it's better to try and lose than to never try. Some may disagree. . .