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Once-Daily Etoricoxib Shows Comparable Safety and Efficacy to Thrice Daily Diclofenac in the Treatment of Osteoarthritis
Current Medical Research and Opinion
01/09/2004
By Deanna M Green, PhD
Etoricoxib is as effective and well tolerated as is diclofenac at improving pain and function in patients with hip or knee osteoarthritis, according to a double-blind, active comparator-controlled, parallel-group study.
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective at reducing pain associated with osteoarthritis. However, their efficacy is limited by gastrointestinal adverse events.
Specific COX-2 inhibitors have been developed that retain efficacy without adversely affecting the gastrointestinal tract. Etoricoxib is a more selective COX-2 inhibitor that has recently been approved in a number of countries for the treatment of arthritis.
Dr. Zafer E. Ozturk with Merck & Co., New Jersey, United States, and international colleagues in the Etoricoxib Osteoarthritis Study Group compared the safety and efficacy of etoricoxib with diclofenac, the most commonly used NSAID, in patients with hip or knee osteoarthritis.
The study included 415 women and 201 men with osteoarthritis who had shown a previous response to NSAIDs. After a 20 day wash-out period, patients were randomised to receive either etoricoxib (60 mg once daily) or diclofenac (50 mg three times daily) for 6 weeks. The Western Ontario McMaster osteoarthritis index (WOMAC) was performed every 2 weeks up to 2 weeks after treatment cessation.
Both treatments were comparably effective at relieving pain. Specifically, the 100 mm visual analogue scale (VAS) measurements decreased from 62 mm before treatment to 31.3 mm with etoricoxib and 30.9 mm with diclofenac. Optimal benefit was seen at 2 weeks and was maintained throughout treatment.
Thirty-two percent of etoricoxib-treated patients reported a good or excellent response just 4 hours after treatment compared to 19% of diclofenac-treated patients (P = .007). However, upon later evaluation, 66% of patients taking etoricoxib and 67% taking diclofenac reported an overall response to therapy.
Similar benefits were also seen for WOMAC stiffness and physical function subscales with both treatments over the 6-week study period.
A favourable safety profile was observed with both treatments. The most common drug related adverse event was gastrointestinal disorders, which was reported by 12.9% of patients taking etoricoxib and 14.2% of those taking diclofenac. Moreover, incidences of peripheral oedema and hypertension were low and similar between groups.
The authors conclude that these results "provide compelling evidence of the effectiveness of etoricoxib in the treatment of patients with osteoarthritis, at its recommended dosage of 60 mg once daily." They also add that "both drugs were generally well tolerated."
Curr Med Res Opin 2003;19:8:725-36.
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