Harvard Health Ad Watch: Can an arthritis drug help you become a morning person?

Perhaps this is obvious, but drug ads are not intended to inform you about the best way to treat a condition you may have. Their primary purpose is to sell a product, as explained in an earlier blog on direct-to-consumer drug ads. And the newest drugs tend to be the most expensive, even though some aren’t much better than older drugs.

So the ads you see for medications are usually not promoting the latest and greatest as much as they are promoting the newest and most expensive. And these ads vary widely in how much accurate, useful information is included and what information is left out. A recent ad for Xeljanz (tofacitinib) is a good example.

The ad: A focus on the morning

A woman is awakened by her son, who is carrying a toy dinosaur. She gives him breakfast, he straps on his dinosaur backpack, and they happily head out the door together. We see them arrive by school bus with his classmates at a museum’s dinosaur exhibit.

The first words you hear in this ad is the tagline, “Mornings were made for better things than rheumatoid arthritis.” I think we can all agree that this is true. But why is this a selling point?

Well, a prominent feature of rheumatoid arthritis (RA) is morning stiffness. People with rheumatoid arthritis are usually much worse in the morning, struggling with an hour or more of stiffness before their joints loosen up. And in this ad, you’ve just seen the main character, a mom who presumably has RA, hop out of bed, full of energy, ready for the day.

The standard sequence for a drug ad

This particular ad follows a familiar sequence by

• describing the approved use of the medication (“for adults with moderate to severe rheumatoid arthritis when methotrexate has not helped enough”)
• noting the benefits of treatment (“…can help relieve joint pain and swelling, stiffness, and help stop further joint damage”)
• swiftly listing possible side effects similar to those of most of the newer and most effective treatments for rheumatoid arthritis, including “serious and sometimes fatal infections” (due to a reduced ability to fend them off) and allergic reactions. More unique to Xeljanz are risks of blood clots and tears in the stomach and intestines.

Odd phrasing is often heard in direct-to-consumer marketing, and seems meant to deflect blame from the drug: according to the ad, cancers, including lymphoma, “have happened.” That might leave you wondering whether these cancers just “happened” while people took the drug, or if they were actually due to the drug?” The ad leaves that question unanswered.

The unspoken messages

Even as the trip to the dinosaur museum begins, words appear on the screen to sing the praises of this medication:

• “Not an injection or infusion.” This is important because many of the other new and most effective drugs for rheumatoid arthritis cannot be taken as a pill. For many people, the fact that Xeljanz is a pill is a major advantage.
• It “…can be taken with or without methotrexate.” Some medications for rheumatoid arthritis are recommended only when taken with methotrexate, a common initial treatment. That’s not true for Xeljanz.
• “The recommended dose of Xeljanz for rheumatoid arthritis is 5 mg twice a day, or 11 mg once a day.” Spelling out this dose in the ad is important, because higher doses of Xeljanz are sometimes prescribed (for example, for patients with ulcerative colitis), and higher doses may come with a higher risk of side effects.

The big finish

The students pose in front of dinosaur skeletons while the mom takes photos. The voiceover returns to the morning theme: “Don’t let another morning go by without asking your doctor about the pill first prescribed for RA more than seven years ago.” That last part is there to remind us that although Xeljanz is a relatively new drug, it’s not brand new. The longer the track record, the less likely that new side effects will be discovered.

The bottom line

This ad gets a lot right about rheumatoid arthritis:

• Symptoms are typically worse in the morning.
• The mom — either a parent chaperone or a teacher — is active and has normal-appearing joints, which rightly suggests that good control of disease is possible.
• It’s important to take a medication that not only reduces symptoms, but also protects joints from damage.
• While methotrexate is often the first choice for rheumatoid arthritis treatment, it doesn’t work well for everyone.

But, as in most ads, some facts go unmentioned. For example, Xeljanz is expensive (in the range of $4,900/month, although insurance coverage and discounts vary). Also, there are more than a dozen other highly effective treatments, some of which may be even more effective and less costly for you.

So, the next time a drug ad interrupts whatever you’re watching or reading, keep in mind that while the ad may be accurate, it may not be complete. As they say in the ads, if you think this product might be right for you, ask your doctor. But a word to the wise: the answer may be “it’s not.” If your doctor thinks a drug is right for you, chances are good they’d have already prescribed it.

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