Source: Nephrologie  |  Posted 8 years ago

Patients with osteoarthritis who did not respond to celecoxib therapy report improved health status and pain relief during treatment with rofecoxib, according to a Spanish study.

Selective inhibitors of type 2 cyclo-oxygenase (COX-2 inhibitors), such as celecoxib and rofecoxib, are commonly used in the treatment of pain and inflammation in patients with osteoarthritis.

Differences in the degree of selectivity between various COX-2 inhibitors can influence the clinical effectiveness of each drug. Furthermore, high variability in individual patient response has been noted in the management of osteoarthritis, emphasising the need to adjust therapies in non-responding patients.

Dr. Eduardo Collantes-Estevez and Dr. Cristina Fernandez-Perez with the Hospital Universitario Reina Sofia, Cordoba, and the Hospital Clinico de San Carlos, Madrid, Spain, evaluated the effects of switching from celecoxib to rofecoxib in the treatment of osteoarthritis in patients not responding to celecoxib therapy.

The open-label multi-centre study included 2,228 patients (average age 66) with osteoarthritis in the knee, spine, hip, or hand and who were taking celecoxib (200 mg/day for most patients). Patients were switched to rofecoxib (25 mg/day) and re-evaluated an average 33 days later. Patient and physician questionnaires at baseline and at follow up were used to assess health status and treatment satisfaction.

Overall, 72.5% of patients reported a "good" or "excellent response with rofecoxib treatments, while only 6.6% of patients had reported such a response with celecoxib treatment. Furthermore, 89.3% of patients expressed some degree of satisfaction with rofecoxib treatment, and 93.2% opted to continue rofecoxib therapy.

Self-reported health status and pain relief also showed significant improvement with rofecoxib treatment. Specifically, "good" or "very good" ratings were reported for health in 50.7% of patients and for pain relief in 55.6%. Significant decreases in self-reported depression were also noted. Physician assessment of patient health and pain relief was similar to that reported by patients.

Further analysis also revealed that age, obesity, depression, diabetes and osteoarthritis-related overall health status were significant predictors of response in patients taking rofecoxib.

The authors conclude from this study that "rofecoxib 25 mg/day is likely to be more effective in patients with osteoarthritis who do not respond well to celecoxib 200 mg/day and satisfies a large proportion of both patients and physicians." They further note that "younger osteoarthritis patients with relatively uncomplicated clinical circumstances (a population in which use of COX-2 inhibitors is relatively low at present) are likely to derive substantial benefit from a switch to rofecoxib therapy."