Background NSAIDs - the main medications for control of musculoskeletal pain in rheumatic diseases (RD). However, their use does not always lead to a significant reduction of pain and may be accompanied by side effects. There is a need to replace the first NSAID with another in many patients.
Objectives To evaluate the results of the use of the selective COX-2 inhibitor etoricoxib in patients with acute/subacute pain related to background RD despite using other NSAIDs.
Methods A group of patients of 1566 patients (63.5% women and 31.1% men, age 48.8 ± 13.9 years) with acute/subacute pain associated with RD (mainly osteoarthritis and back pain) was included in an open-label study. The criterion for selection of patients was dissatisfaction with the treatment (10 cm VAS pain >3 cm) by background NSAIDs. The patients mainly used diclofenac (24.5%), nimesulide (27.2%) and meloxicam (25.6%). After inclusion in the study all patients started etoricoxib instead of other NSAIDs. The dose and duration of treatment were determined by a physician: the majority of patients (59.6%) took etoricoxib 90 mg/day. The results of treatment were assessed after 2 weeks.
Results After start of treatment with etoricoxib a significant improvement was observed in the majority of patients. Pain decreased from 6.21 ± 1.4 to 1.93 ± 1.3 cm VAS. The complete pain relief was achieved in 12.5% of patients, 58.3% achieved low intensity of pain (VAS <2 cm). Additional therapy for symptom control (muscle relaxants, other analgesics, local injections of glucocorticoids, and others) needed in 31.2% of patients. The best effect was observed when using a higher dose of etoricoxib: decrease of pain intensity on 120 mg, 90 mg and 60 mg per day was 4.77 ± 1.88, 4.69 ± 2.01 and 3.50 ± 1.48 cm VAS respectively (the difference between 120 and 60 mg/day, 90 and 60 mg/day was significant, p<0.001). Treatment tolerability was assessed as “good” in 62.7%, "satisfactory" in 36.7% and "bad" in 0.6% of patients. Adverse events were reported in 55 patients (3.5%), mainly dyspepsia – in 21 (1.3%) and arterial hypertension - in 27 patients (1.7%).
Conclusions Switching from previous therapy with NSAIDs to etoricoxib provides an effective reduction of acute/subacute pain. High doses etoricoxib are more effective. Short-term use of etoricoxib rarely causes adverse events.
Disclosure of Interest None declared