Una reseña de: «Una comparación de la eficacia y tolerancia terapéutica del etoricoxib y el diclofenaco en pacientes con oseoartritis»
Etoricoxib offers overall clinical efficacy comparable to diclofenac, along with superior early efficacy, and is well tolerated in patients with osteoarthritis, reports an international, multicentre study.
Although the mainstay of treatment for osteoarthritis has been the non-steroidal anti-inflammatory drugs (NSAIDs), among which diclofenac is the most commonly used, the high rate of adverse effects – primarily to the gastrointestinal tract – has encouraged interest in other types of therapies such as selective COX-2 inhibitors. Etoricoxib is one agent in this class of drugs that has recently been approved in many countries to treat arthritic diseases.
In this 6-week, double-blind, controlled trial of 516 patients from 29 countries with osteoarthritis (OA) of the hip or knee, J. Zacher, MD, Orthopadische Klinik, HELIOS Klinikum Berlin-Klinikum Buch, Germany and colleagues, randomised 256 patients to etoricoxib (60 mg once daily) and 260 to diclofenac (50 mg three times daily) to evaluate and compare the efficacy and safety of these 2 treatments. Of the 516 patients with a mean age of 63 years, 80% were female, 81% Caucasian, and 77% had OA of the knee.
Over the 6-week study period, both treatments provided comparable efficacy in pain relief as measured by the WOMAC pain subscale, with the maximum effect of treatment seen at 2 weeks after treatment initiation and persisting throughout the study period. Comparable efficacy was also reported by secondary analyses that examined stiffness and physical function and patient’s global response to therapy. Etoricoxib achieved significantly greater early clinical efficacy than diclofenac, showing a benefit within 4 hours of dosing on the first day of therapy (P = .007). By day 2 of treatment, both drugs showed comparable treatment effect.
Tolerability of both drugs was generally favourable over the study period, with comparable low numbers of gastrointestinal adverse events and hypertension. In patients treated with diclofenac, however, 1.2% had increases in liver enzymes that exceeded 3 times the upper limit of normal compared to no such changes in the etoricoxib treated patients.
Overall, this study shows comparable efficacy and tolerability between etoricoxib and diclofenac in the treatment of osteoarthritis, with etoricoxib showing superior early efficacy and was not associated with elevated liver enzymes. The authors conclude that «these data help endorse etoricoxib as a credible treatment option in the symptomatic management of osteoarthritic patients.»
Curr Med Res Opin 2003;19:8:725-36.