Celecoxib gives the same level of anti-inflammatory activity as diclofenac but with a lower frequency of gastrointestinal (GI) side effects, according to Professor Paul Emery (department of rheumatology, University of Leeds) and colleagues.
In a study of 655 patients with rheumatoid arthritis, the anti-inflammatory, analgesic and GI effects of celecoxib and diclofenac were assessed. Patients were randomly assigned treatment with celecoxib 200mg twice daily or diclofenac slow release 75mg twice daily for 24 weeks. Approximately three-quarters of the patients completed the trial. Among those who did not, the time to withdrawal of treatment and the reasons for not completing the trial were similar in both groups.
The results showed that the two treatments were similarly effective in managing the pain and inflammation of rheumatoid arthritis, the researchers say. However, the prevalence of gastroduodenal ulcers detected on endoscopy in patients receiving celecoxib was nearly four-fold lower than in those taking diclofenac. Mean ulcer size was smaller in the celecoxib group. In addition, the occurrence of GI side effects was lower for celecoxib, with adverse events reported by 48 per cent of patients taking diclofenac and 36 per cent of those taking celecoxib (Lancet 1999;354:2106).
Celecoxib (Celebrex) is not yet available in the UK although it is licensed in the US. A spokesperson for Searle told The Journal on January 4 that it was currently awaiting European licensing approval for celecoxib which it hoped to receive in the first half of the year.