The Pharmaceutical Journal
Vol 271 No 7256 p7
5 July 2003

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COX-2s show promise outside rheumatology

Cyclo-oxygenase-2 selective inhibitors (COX-2 inhibitors) could have uses outside arthritis, according to study data presented at this year's European League Against Rheumatism meeting held in Lisbon last month. Migraine and low back pain are both conditions for which trial work with COX-2s is starting to emerge.

Researchers compared 60mg and 90mg doses of etoricoxib (Arcoxia) with placebo in 314 patients with lower back pain for three months. After one week of treatment back pain intensity scores were better for both active groups than placebo (P<0.05). For the 60mg etoricoxib group there was a 36-point drop in pain intensity after four weeks compared with a 23-point drop in the placebo arm (P<0.005). This effect was maintained for 12 weeks with similar results for the 90mg dose. Functional disability scores also improved.

The migraine study looked at two doses of rofecoxib (Vioxx), 25mg and 50mg, compared with placebo in 557 patients.

Two hours after taking the dose, 34 per cent of patients in the placebo group had relief from their headache (defined as moderate to severe pain improving to mild or no pain). For active treatment, the corresponding figures were 54 per cent for the 25mg dose of rofecoxib and 57 per cent for the 50mg dose (P<0.001 compared with placebo for both figures).

Furthermore, two hours after taking the dose 8 per cent of those taking placebo had no pain compared with 20 per cent of those taking 25mg rofecoxib and 23 per cent of those taking the 50mg dose (P=0.002 and P<0.001 compared with placebo, respectively).

Dr Andrew Moore, honorary director of pain research at the University of Oxford said the usefulness of COX-2s in areas of analgesia other than arthritis was largely down to the drugs' duration of action. "Data we have produced for Bandolier suggests the coxibs give tremendous long-acting pain relief," he said.

He added that better treatments for lower back pain would be especially useful.