The Pharmaceutical Journal
Vol 268 No 7204 p895-899
29 June 2002

This article
Reprint
Photocopy

News summary

Related websites
BMJ (bmj.com)

COX-2 effective for gout

ETORICOXIB (Arcoxia) is as effective as indometacin at relieving the pain from acute episodes of gouty arthritis, a double blind trial of the two treatments has shown.

Although the non-steroidal anti-inflammatory drug indometacin has been considered the most effective treatment for acute gouty arthritis, few large clinical trials have been carried out. The researchers therefore decided to compare indometacin treatment with a selective cyclo-oxygenase-2 inhibitor, etoricoxib, in 150 patients with clinically diagnosed acute gout who presented within 48 hours of onset. The trial was funded by Merck Research Laboratories.

In all, 142 men and eight women were randomised to receive etoricoxib 120mg orally once daily, or indometacin 50mg orally three times daily, for eight days.

The main outcome measures were patients' own assessments of pain in the affected joint from the second to the fifth day of study, as well as the researchers' and patients' overall assessment of response to treatment and joint tenderness.

Both drugs were effective at relieving pain during days two to five of the study as well as for the eight-day treatment period, according to patients' assessments of their pain. Etoricoxib was broadly similar to indometacin in terms of patients' and clinicians' assessments of response to treatment, and both drugs had similar effects on joint tenderness and swelling.

Five patients discontinued treatment (three in the etoricoxib group and two in the indometacin group), and four serious adverse effects occurred — all among patients taking indometacin. Only two of these events, vomiting and headache, were judged to be drug related (BMJ 2002; 324:1488).

The researchers comment that although both drugs were safe and well tolerated, the study was too small to allow a rigorous safety assessment to be carried out. "The data on drug-related clinical adverse experiences show that etoricoxib may be better tolerated than indometacin, but additional studies are needed to enable definitive conclusions on safety to be drawn."