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Pharmacy NewsMonday 8 September 2008
Trial Comparison Will Help In Treatment Of Arthritis
Incidence of upper gastrointestinal clinical events in patients with arthritis on the COX-2 inhibitor etoricoxib are fewer than in those patients on the NSAID* diclofenac, according to an Article in this week's issue of The Lancet. This information will assist patients with arthritis and their physicians in making decisions about pain management.
NSAIDS are often taken long term by arthritis patients. However, they significantly increase the risk of upper gastrointestinal clinical events such as bleeding ulcers. The incidences of upper gastrointestinal clinical events have been shown to be significantly less with COX-2 than traditional NSAIDS. However, previous trials have not simulated standard clinical practice because gastrointestinal protective therapies - eg, proton pump inhibitors (PPIs) - were not allowed.
Loren Laine (University of Southern California Keck School of Medicine, Los Angeles, USA) and colleagues analyse data from three randomised trials from the MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-term) programme† to assess the effects of COX-2 inhibitors versus traditional NSAIDS on upper gastrointestinal outcomes in a setting that simulates real-world practice, in which patients with gastrointestinal risk factors were encouraged to use protective PPI therapy and those with cardiovascular risk were encouraged to take low-dose aspirin. Overall, upper gastrointestinal clinical events were significantly less common with etoricoxib than with diclofenac, but not in the more serious complicated events‡. The treatment effects did not differ significantly in individuals using PPIs or aspirin.
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