Upper GI safety of etoricoxib superior to that of diclofenac for arthritis, study suggests
Using etoricoxib (Arcoxia) rather than diclofenac reduces the number of uncomplicated upper gastrointestinal events in patients with arthritis, a new analysis of data from the MEDAL study suggests.
The cardiovascular
results of the MEDAL (multinational etoricoxib and
diclofenac arthritis long-term) programme, which includes 34,701 patients
with osteoarthritis or rheumatoid arthritis, were announced last year
(PJ, 18 November 2006, p599; Lancet 2006; 368:1771). Last week saw publication
of an assessment of the upper gastrointestinal safety of etoricoxib and
diclofenac in the MEDAL patients (Lancet 2007;369:465).
The new analysis shows that overall upper gastrointestinal clinical events
were less common with etoricoxib than with diclofenac, due to a decrease
in uncomplicated events (hazard ratio 0.59, 95 per cent confidence interval
0.45–0.74; P<0.0001), but that there was no difference in the
number of complicated events.
The authors of an accompanying editorial (ibid, p439) argue that the
results could have important ramifications, because the use of these
drugs in a susceptible population is often limited by gastrointestinal
toxicity. However, the editorial also highlights the shortcomings of
the findings. “We would need to treat 259 patients with etoricoxib
to prevent one uncomplicated gastrointestinal event in one patient,” the
authors say. “So, although the effect might well be statistically
significant, the effect is certainly not large and might not be clinically
relevant.”
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