Etoricoxib improves pain, function and quality of life: results of a real-world effectiveness trial.
ABSTRACT To evaluate the effectiveness and tolerability of etoricoxib in patients with osteoarthritis (OA) with suboptimal response to existing pain regimens.
A multicenter, prospective, open-label, single-arm study. OA patients (n = 500) taking nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics who had inadequate response as determined by their physicians (>or= 40 mm on a 0-100 mm pain scale) were switched directly to etoricoxib 60 mg once daily for 4 weeks without prior medication washout. The primary endpoint was the percentage of patients with >or= 30% improvement in Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain walking on a flat surface after 4 weeks of treatment. Other endpoints included WOMAC Pain, Stiffness, and Physical Function subscales, Brief Pain Inventory (BPI), investigator's global assessment of response to therapy (IGART), the Treatment Satisfaction Questionnaire for Medication (TSQM) and Short Form 36 (SF36). Safety and tolerability were assessed by collecting adverse events.
After switching to etoricoxib, 52% (95% confidence interval: 47%, 57%) of patients reported a clinically meaningful reduction (>or= 30%) for WOMAC pain walking on a flat surface. Disability in daily activities and pain interference were significantly improved (P < 0.0001). IGART scores improved after the switch to etoricoxib (P < 0.05). Results from TSQM demonstrated that patient perceptions of effectiveness, convenience and overall satisfaction increased. Etoricoxib was generally well tolerated in most patients. The most commonly reported adverse event was edema (4.2%).
In OA patients experiencing inadequate relief from a wide variety of analgesics, pain, function, quality of life, and treatment satisfaction significantly improved when switched to etoricoxib.
[Show abstract] [Hide abstract]
ABSTRACT: There has been a tension between the needs of regulators and industry to demonstrate that interventions are effective and safe, and the needs of professionals to understand how well interventions will work for their patients, and patients to understand what might work for them as individuals. The custom has been to focus on statistical outcomes based on average results, but in-depth analysis based on outcomes obtained by individual patients demonstrates that few are average. Rather, a minority of patients achieve very large reductions in pain (responders), while the majority achieve little (nonresponders). Those who benefit in terms of pain also benefit in other areas, with improved sleep, fatigue, mood, function, quality of life, and ability to work. This changes how benefit and risk are seen; nonresponders should stop treatments that don't work and not, therefore, be exposed to risks, while responders have very large benefits to offset against rare but potentially serious harm. This alternative view, patient-centred and practice-orientated, has major implications for clinical practice, how and why we do clinical trials and how they are designed, how health economic evaluations are done, for decisions made by regulatory and other bodies, and for the theory and practice of evidence-based medicine.Pain 03/2013; 154. DOI:10.1016/j.pain.2013.03.024 · 5.84 Impact Factor
BMJ (online) 05/2013; 346:f2690. DOI:10.1136/bmj.f2690 · 16.38 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Chronic multiple-site joint pain (MSJP) due to osteoarthritis and soft tissue disorders is common in people over 50 years old and associated with poor outcomes. This study examined current pharmacological approaches to MSJP management in primary care. One hundred and fifty general practitioners (GPs) attending an educational seminar participated in an electronic survey (mean response rate 96%). Most GPs reported treating multiple painful joints concurrently (78%) compared with focusing on a single joint (21%). The majority believed there was no difference in analgesia for different disorders when selecting paracetamol (84%), non-steroidal anti-inflammatory drugs (NSAID)/COX-2 inhibitors (57%) or opioids (70%). When optimising therapy, intra-class optimisation (increase NSAID dose 41%, change to another NSAID/COX-2 inhibitor 30%) was preferred to inter-class step up therapy (add opioid 23%, change to opioid 6%). For NSAID gastrointestinal intolerance, the preference was to add a gastro-protective agent (74%). There is a need to better characterise MSJP and examine optimal pharmacotherapy regimens.Primary Health Care Research & Development 01/2014; DOI:10.1017/S1463423613000546