Alaska and 32 other states share in $60 million settlement
October 25, 2008
"This judgment, along with our other recent drug cases, should send a strong message to the pharmaceutical industry that we will not tolerate deceptive and misleading drug promotion. The comprehensive injunctive relief obtained in this case is outstanding and addresses all concerns identified over five years of investigation," Colberg said.
The multistate investigation was initiated in 2003 to determine whether Pfizer and another drug company Pharmacia, subsequently purchased by Pfizer, misrepresented that their jointly sold "Cox-2" drug Celebrex was safer and more effective than traditional non-steroidal anti-inflammatory drugs (NSAIDS) such as Ibuprofen (Advil®) and naproxen (Aleve®). As the investigation proceeded, additional concerns were raised regarding Pfizer's second generation Cox-2 drug Bextra. Ultimately, the investigation concluded that Pfizer engaged in an aggressive, deceptive and unlawful campaign to promote Bextra "off label" for uses that had been expressly rejected by the Food and Drug Administration (FDA). "Off-label" uses are uses that are not approved by the FDA. While a physician is allowed to prescribe drugs for off-label uses, law prohibits pharmaceutical manufacturers from marketing their products for off-label uses.
Cheap, generically available NSAIDS have been used for many years to treat pain and inflammation; however, NSAIDS have the potential to cause serious gastro intestinal (GI) side effects such as bleeds and perforations. The Cox-2 drugs Celebrex, Vioxx and Bextra were designed to reduce pain and inflammation without the negative GI side effects of traditional NSAIDS. Although significantly more expensive than traditional NSAIDS, Cox-2 drugs have not been shown to be more effective relieving pain than traditional NSAIDS and neither Celebrex nor Bextra were ever proven to significantly reduce serious GI adverse events compared to traditional NSAIDS. Moreover, there are significant concerns that all three Cox-2 drugs increase the risk of serious cardiovascular adverse events such as heart attacks and strokes. Bextra also carries a risk of a serious and sometimes fatal skin condition. In 2005, due to safety concerns, Bextra and Vioxx were withdrawn from the market place and FDA required a "black box" safety warning for Celebrex.
In its Complaint, the State alleges that despite the fact that significant safety concerns led FDA to reject a request to market high dose Bextra for acute and surgical pain, Pfizer conducted a systematic, multi-pronged "off-label" promotional campaign for these very indications FDA denied by:
The State alleges these efforts
continued even after Pfizer completed a study that confirmed
FDA's reason for rejecting the acute and surgical pain indications
for Bextra. This study ultimately contributed to FDA's decision
to withdraw Bextra from the marketplace, even at the low doses
that had been previously approved.
In addition, the judgment requires Pfizer to submit all "direct-to-consumer" (DTC) television drug advertisements to the Food and Drug Administration (FDA) for approval and comply with any FDA comment before running the advertisement. If FDA does not respond within 45 days, Pfizer may run the advertisement but must still comply with any subsequent FDA comments regarding the advertisement and must notify the State that it is running the advertisement without FDA authorization. For any new drug for pain relief, Pfizer must delay direct-to-consumer advertising for up to 18 months should FDA recommend such a delay. Finally, the judgment generally prohibits Pfizer from deceptive and misleading advertising and promotion of any Pfizer drug, requires Pfizer to register all clinical trials, post clinical trial results, and ensure that subjects in Pfizer sponsored clinical trials give adequate informed consent.
Joining Alaska in this week's
settlement are: Arizona, Arkansas, California, Connecticut,
Florida, District of Columbia, Idaho, Illinois, Iowa, Kansas,
Maine, Maryland, Massachusetts, Michigan, Montana, Nebraska,
Nevada, New Jersey, New Mexico, New York, North Carolina, North
Dakota, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota,
Tennessee, Texas, Vermont, Washington, and Wisconsin.
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