Lumiracoxib in the treatment of osteoarthritis, rheumatoid arthritis and acute postoperative dental pain: results of three dose-response studies

Schnitzer, Thomas J.; Fricke, James R.; Gitton, Xavier; Jayawardene, S.; Sloan, Victor S.

doi:10.1185/030079904x20231

Cited by 19 publications

(9 citation statements)

References 20 publications

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“…For example, two other studies which have assessed pain in patients with acute Gouty Arthritis using a 5-point Likert scale have reported that 49 to 53% [38] and 89% of patients had severe or extreme pain at baseline [36], whereas two studies which have employed a 0 to 100 mm VAS reported baseline scores of 59 to 62 mm [37] and 74 to 78 mm during activity [39]. These scores suggest that pain associated with acute flares is at least as great or greater than that experienced by patients with osteoarthritis (OA) (mean VAS score, 68 mm [40]) or rheumatoid arthritis (RA) (mean VAS scores of 64 to 67 mm [40] and 62 mm [41] have been reported). Rapid effective pain relief is, therefore, a priority for management of acute Gouty Arthritis.…”

Section: Discussionmentioning

confidence: 99%

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study

Meulemeester²,

et al. 2011

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IntroductionWe report the impact of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, on inflammation and health-related quality of life (HRQoL) in patients with difficult-to-treat Gouty Arthritis.MethodsIn this eight-week, single-blind, double-dummy, dose-ranging study, patients with acute Gouty Arthritis flares who were unresponsive or intolerant to - or had contraindications for - non-steroidal anti-inflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg) (N = 143) or an intramuscular dose of triamcinolone acetonide 40 mg (N = 57). Patients assessed pain using a Likert scale, physicians assessed clinical signs of joint inflammation, and HRQoL was measured using the 36-item Short-Form Health Survey (SF-36) (acute version).ResultsAt baseline, 98% of patients were suffering from moderate-to-extreme pain. The percentage of patients with no or mild pain was numerically greater in most canakinumab groups compared with triamcinolone acetonide from 24 to 72 hours post-dose; the difference was statistically significant for canakinumab 150 mg at these time points (P < 0.05). Treatment with canakinumab 150 mg was associated with statistically significant lower Likert scores for tenderness (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.27 to 7.89; P = 0.014) and swelling (OR, 2.7; 95% CI, 1.09 to 6.50, P = 0.032) at 72 hours compared with triamcinolone acetonide. Median C-reactive protein and serum amyloid A levels were normalized by seven days post-dose in most canakinumab groups, but remained elevated in the triamcinolone acetonide group. Improvements in physical health were observed at seven days post-dose in all treatment groups; increases in scores were highest for canakinumab 150 mg. In this group, the mean SF-36 physical component summary score increased by 12.0 points from baseline to 48.3 at seven days post-dose. SF-36 scores for physical functioning and bodily pain for the canakinumab 150 mg group approached those for the US general population by seven days post-dose and reached norm values by eight weeks post-dose.ConclusionsCanakinumab 150 mg provided significantly greater and more rapid reduction in pain and signs and symptoms of inflammation compared with triamcinolone acetonide 40 mg. Improvements in HRQoL were seen in both treatment groups with a faster onset with canakinumab 150 mg compared with triamcinolone acetonide 40 mg.Trial registrationclinicaltrials.gov: NCT00798369.

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Section: Discussionmentioning

confidence: 99%

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study

Meulemeester²,

et al. 2011

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“…Twenty-eight studies with close to 60,000 patients assessed the effect of low- or high-dose COX-2s compared to tNSAIDs for treatment related overall GI side effects, dyspepsia, nausea, and abdominal pain 69,70,75–77,82,86,87,89,90,96–98,101,104,106,107,111,112,114,122,124. Low-dose COX-2s were associated with a lower relative risk of GI symptoms (RR 0.78; 95% CI 0.74 to 0.82); dyspepsia (RR 0.83; 95% CI 0.75 to 0.90); nausea (RR 0.72; 95% CI 0.64 to 0.82); and abdominal pain (RR 0.64; 95% CI 0.58 to 0.70).…”

Section: Part II – Cox-2 Inhibitorsmentioning

confidence: 99%

“…Low-dose COX-2s were associated with a slight but statistically significant increased relative risk of overall GI symptoms (RR 1.26; 95% CI 1.13 to 1.42); dyspepsia (RR 1.28; 95% CI 1.08 to 1.51); nausea (RR 1.24; 95% CI 1.01 to 1.53); and abdominal pain (RR 1.24; 95% CI 1.02 to 1.52) 76,80,86,87,89,90,94,96,97,99,100,104,106–108,122,123–126. The results for high-dose COX-2s were similar.…”

Section: Part II – Cox-2 Inhibitorsmentioning

confidence: 99%

Prevention of NSAID-related upper gastrointestinal toxicity: a meta-analysis of traditional NSAIDs with gastroprotection and COX-2 inhibitors

Rostom

Muir²,

Dubé³

et al. 2009

DHPS

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Background:Traditional NSAIDs (tNSAIDs) and COX-2 inhibitors (COX-2s) are important agents for the treatment of a variety or arthritic conditions. The purpose of this study was to systematically review the effectiveness of misoprostol, H2-receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) for the prevention of tNSAID related upper gastrointestinal (GI) toxicity, and to review the upper gastrointestinal (GI) safety of COX-2s.Methods:An extensive literature search was performed to identify randomized controlled trials (RCTs) of prophylactic agents used for the prevention of upper GI toxicity, and RCTs that assessed the GI safety of the newer COX-2s. Meta-analysis was performed in accordance with accepted techniques.Results:39 gastroprotection and 69 COX-2 RCTs met inclusion criteria. Misoprostol, PPIs, and double doses of H2RAs are effective at reducing the risk of both endoscopic gastric and duodenal tNSAID-induced ulcers. Standard doses of H2RAs are not effective at reducing the risk of tNSAID-induced gastric ulcers, but reduce the risk of duodenal ulcers. Misoprostol is associated with greater adverse effects than the other agents, particularly at higher doses. COX-2s are associated with fewer endoscopic ulcers and clinically important ulcer complications, and have fewer treatment withdrawals due to GI symptoms than tNSAIDS. Acetylsalicylic acid appears to diminish the benefit of COX-2s over tNSAIDs. In high risk GI patients, tNSAID with a PPI or a COX-2 alone appear to offer similar GI safety, but a strategy of a COX-2 with a PPI appears to offer the greatest GI safety.Conclusion:Several strategies are available to reduce the risk of upper GI toxicity with tNSAIDs. The choice between these strategies needs to consider patients’ underlying GI and cardiovascular risk.

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“…It should be noted that one of the four articles selected was excluded (study by Schnitzer et al) 10 because it used data from a study previously published (Zelenakas et al). 6 The results from clinical trials may, in practice, be limited.…”

Section: Discussionmentioning

confidence: 99%

Lumiracoxib for acute postoperative dental pain: a systematic review of randomized clinical trials

Silva¹,

Riera

Saconato

2011

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Lumiracoxib is an anti-inflammatory drug that has been used to treat acute dental pain, mainly in postsurgical settings, in which the greatest levels of pain and discomfort are experienced during the first 24 hours. This study aimed to assess the efficacy and safety of lumiracoxib for treating acute postsurgical dental pain. DESIGN AND SETTING: Systematic review developed at the Brazilian Cochrane Centre, Universidade Federal de São Paulo. METHODS: An electronic search was conducted in the PubMed, Cochrane Library, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) and Embase databases. A manual search was also performed. Only randomized controlled trials were included, and these were selected and assessed by two researchers with regard to the risk of bias. RESULTS: Three clinical trials with 921 participants were included. Lumiracoxib 400 mg produced onset of analgesia in a shorter time than shown by lumiracoxib 100 mg, celecoxib 200 mg and ibuprofen 400 mg. There was no difference between lumiracoxib 400 mg and rofecoxib 50 mg. In two studies, the mean time taken to attain onset of analgesia for the placebo was not estimated because the number of participants who reached onset was too small. CONCLUSION: There is evidence with a moderate risk of bias that recommends the use of lumiracoxib for acute postoperative dental pain. However, the adverse effects are not completely known. Given that lumiracoxib is currently available in only three countries, further studies are likely to be rare and discouraged.reSUmO CONTEXTO E OBJETIVO: O lumiracoxibe é um anti-inflamatório que tem sido utilizado no tratamento de dor dental aguda, principalmente no cenário pós-cirúrgico, no qual níveis mais elevados de dor e desconforto são sentidos durante as primeiras 24 horas. Este estudo teve por objetivo avaliar a eficácia e a segurança do lumiracoxibe no tratamento da dor dental aguda e pós-operatória.

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Lumiracoxib in the treatment of osteoarthritis, rheumatoid arthritis and acute postoperative dental pain: results of three dose-response studies

Abstract: These studies provide initial evidence that lumiracoxib is an effective, well-tolerated agent for the treatment of chronic and acute pain.

Cited by 19 publications

References 20 publications

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study

Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study

Prevention of NSAID-related upper gastrointestinal toxicity: a meta-analysis of traditional NSAIDs with gastroprotection and COX-2 inhibitors

Lumiracoxib for acute postoperative dental pain: a systematic review of randomized clinical trials

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