![[ Visit Client Website ]](images/banner.gif)
Objective: To evaluate the relative efficacy of Etoricoxib (30 and 60mg) vs. orally administered acetaminophen, traditional NSAIDs (tNSAIDs) and COX-2 selective NSAIDs (COX-2) in the treatment of osteoarthritis (OA).
Method: A systematic search of Medline and EMBASE identified 20 published full reports on acetaminophen (4g), tNSAIDs (naproxen 1000 mg, dexibuprofen 800 mg, ibuprofen 2400 mg, dicloflenac 150 mg), COX-2 (celecoxib 100, 200, 400 mg, lumiracoxib 100, 200, 400 mg). In addition 8 clinical study reports (phase IIb and III) provided data on the efficacy of etoricoxib 30 and 60 mg vs. celecoxib 200 mg, diclofenac 150 mg, naproxen 1000 mg, ibuprofen 2400 mg and placebo in OA patients. Efficacy was assessed with the WOMAC Pain and Physical Function Subscales and with the Patient Global Assessment of Disease Status (PGADS). As pain and physical function were reported on different scales (VAS or LIKERT), their relative differences were translated into effect sizes (ES). The different head-to-head findings were combined simultaneously with a Bayesian meta-analysis. As compared to frequentist approach, Bayesian meta-analysis offers a more informative summary of the likely value of efficacy after observing the data and allows for direct probabilistic inferences. For PGADS (0-100 mm VAS scale), a relative change from baseline (CFB) equal or greater than 10 mm was considered a clinical significant response. For pain and physical function, an ES ≥ 0.8 was defined as “large” clinical treatment effect; effect sizes of 0.5 and 0.2 were defined as "moderate” and “small”, respectively.
Results: For all outcome parameters there is > 98% probability that etoricoxib offered clinical benefits compared to placebo. Compared to other COX-2s (at doses of 100, 200, 400 mg) etoricoxib (30 and 60 mg) displayed probabilities ranging form 21% - 85% of providing small benefits with regard to pain and physical function. Compared to tNSAIDs, the probability that etoricoxib provided small benefits ranged from 31-64%, for pain and physical function. Compared to acetaminophen, etoricoxib (30 and 60 mg) displayed the highest likelihood for providing improvements (based on ES) in pain and physical function (75%-93% probability for small improvement; 30%-54% for offering moderate improvement). PGADS was reported for naproxen, ibuprofen, dicloflenac, celecoxib 200 mg and lumiracoxib 100, 200 and 400 mg. All these treatments showed comparable efficacy for PGADS: relative CFB of about 10-15 mm vs. placebo (-14.21 and -16.22 mm on VAS scale for etoricoxib 30 and 60 mg).
Conclusion: With regard to the outcomes pain and physical function, etoricoxib (30 and 60 mg) was more likely to show greater benefits than tNSAIDs and other COX-2s. Etoricoxib displayed an efficacy equal to tNSAIDs and other COX-2s regarding PGADS.
Method: A systematic search of Medline and EMBASE identified 20 published full reports on acetaminophen (4g), tNSAIDs (naproxen 1000 mg, dexibuprofen 800 mg, ibuprofen 2400 mg, dicloflenac 150 mg), COX-2 (celecoxib 100, 200, 400 mg, lumiracoxib 100, 200, 400 mg). In addition 8 clinical study reports (phase IIb and III) provided data on the efficacy of etoricoxib 30 and 60 mg vs. celecoxib 200 mg, diclofenac 150 mg, naproxen 1000 mg, ibuprofen 2400 mg and placebo in OA patients. Efficacy was assessed with the WOMAC Pain and Physical Function Subscales and with the Patient Global Assessment of Disease Status (PGADS). As pain and physical function were reported on different scales (VAS or LIKERT), their relative differences were translated into effect sizes (ES). The different head-to-head findings were combined simultaneously with a Bayesian meta-analysis. As compared to frequentist approach, Bayesian meta-analysis offers a more informative summary of the likely value of efficacy after observing the data and allows for direct probabilistic inferences. For PGADS (0-100 mm VAS scale), a relative change from baseline (CFB) equal or greater than 10 mm was considered a clinical significant response. For pain and physical function, an ES ≥ 0.8 was defined as “large” clinical treatment effect; effect sizes of 0.5 and 0.2 were defined as "moderate” and “small”, respectively.
Results: For all outcome parameters there is > 98% probability that etoricoxib offered clinical benefits compared to placebo. Compared to other COX-2s (at doses of 100, 200, 400 mg) etoricoxib (30 and 60 mg) displayed probabilities ranging form 21% - 85% of providing small benefits with regard to pain and physical function. Compared to tNSAIDs, the probability that etoricoxib provided small benefits ranged from 31-64%, for pain and physical function. Compared to acetaminophen, etoricoxib (30 and 60 mg) displayed the highest likelihood for providing improvements (based on ES) in pain and physical function (75%-93% probability for small improvement; 30%-54% for offering moderate improvement). PGADS was reported for naproxen, ibuprofen, dicloflenac, celecoxib 200 mg and lumiracoxib 100, 200 and 400 mg. All these treatments showed comparable efficacy for PGADS: relative CFB of about 10-15 mm vs. placebo (-14.21 and -16.22 mm on VAS scale for etoricoxib 30 and 60 mg).
Conclusion: With regard to the outcomes pain and physical function, etoricoxib (30 and 60 mg) was more likely to show greater benefits than tNSAIDs and other COX-2s. Etoricoxib displayed an efficacy equal to tNSAIDs and other COX-2s regarding PGADS.
W.B. Stam, The study was sponsored by Merck & Co Inc (contract agreement), 2; S. Gaugris, Stocks, 1; Full time employment, 3; J. van Bavel, Stocks and stocks options, 1; Employed by MSD Australia, 3; J. Jansen, The study was sponsored by Merck & Co Inc (contract agreement), 2.
See more of: Epidemiology and Health Services Research III
See more of: ACR Abstract Submission Poster Sessions
See more of: ACR Abstract Submission Poster Sessions