Titre du document / Document title

Efficacy of Rofecoxib, celecoxib, and acetaminophen in Osteoarthritis of the knee: A randomized trial

Auteur(s) / Author(s)

VACT Group
GEBA Gregory P. ⁽¹⁾ ; WEAVER Arthur L. ; POLIS Adam B. ; DIXON Mary E. ; SCHNITZER Thomas J. ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Merck & Co Inc, US Human Health, PO Box 4, West Point, PA 19486-0004, ETATS-UNIS

Résumé / Abstract

Context Osteoarthritis (OA) is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or specific inhibitors of cyclooxygenase 2 (COX-2). Objective To assess the relative therapeutic efficacy of rofecoxib, celecoxib, and acetaminophen in adults with OA. Design and Setting Randomized, parallel-group, double-blind trial, conducted from June 1999 to February 2000, in 29 clinical centers in the United States. Patients Three hundred eighty-two patients aged at least 40 years who had OA of the knee that was previously treated with NSAIDs or acetaminophen. Interventions Patients were randomly assigned to receive rofecoxib, 12.5 mg/d (n = 96); rofecoxib, 25 mg/d (n = 95); celecoxib, 200 mg/d (n = 97); or acetaminophen, 4000 mg/d (n = 94) for 6 weeks. Main Outcome Measures Assessments over days 1 to 6 and over 6 weeks included pain on walking, night pain, pain at rest, and morning stiffness as measured on a Western Ontario McMaster Universities Osteoarthritis Index (100-mm visual analog scale [VAS]) and global response to therapy compared among 4 treatment groups. Results 79% of patients completed the study. More patients treated with acetaminophen discontinued early due to lack of efficacy than patients treated with COX-2 inhibitors (31 % vs 18%-19%). Efficacy assessed in the first 6 days of therapy showed greatest response to rofecoxib, 25 mg/d, followed by rofecoxib, 12.5 mg/d, celecoxib, and acetaminophen, respectively, in terms of relief of pain on walking (-32.2, -29.0, -26.4, and -20.6 mm change on the VAS; P≤.04 for all others vs acetaminophen; P=.05 for 25-mg rofecoxib vs celecoxib), rest pain (-21.8, -18.6, -15.5, and -12.5 mm; P≤.02 for either dose of rofecoxib vs acetaminophen and P =.02 for rofecoxib, 25 mg/d, vs celecoxib), night pain (-25.2, -22.0, -18.7, and -18.8 mm; P =.04 for rofecoxib, 25 mg/d, vs both acetaminophen and celecoxib), and morning stiffness (-30.4,-28.4,-25.7, and -20.9 mm; P≤.02 for either dose of rofecoxib vs acetaminophen). Over 6 weeks, rofecoxib, 25 mg/d, provided greatest response for night pain (P<.002 vs celecoxib and P=.006 vs acetaminophen and P=.02 vs rofecoxib, 12.5 mg/d), composite pain subscale (P≤.03 vs all other treatments), stiffness subscale (P≤.04 vs celecoxib and acetaminophen), and physical function subscale (P=.001 vs acetaminophen). Global responses over 6 weeks showed a similar pattern (good or excellent response at week 6: 60%, 56%, 46%, and 39%, respectively; P≤.03 for rofecoxib, 25 mg/d, vs celecoxib and acetaminophen; P=.02 for rofecoxib, 12.5 mg/d, vs acetaminophen). All treatments were generally safe and well tolerated. Conclusion Rofecoxib, 25 mg/d, provided efficacy advantages over acetaminophen, 4000 mg/d, celecoxib, 200 mg/d, and rofecoxib, 12.5 mg, for symptomatic knee OA.

Revue / Journal Title

JAMA, the journal of the American Medical Association   ISSN 0098-7484 

Source / Source

2002, vol. 287, n^o1, pp. 64-71 (30 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Medical Association, Chicago, IL, ETATS-UNIS  (1960) (Revue)

Mots-clés anglais / English Keywords

Chemotherapy ; Lower limb ; Arthropathy ; Diseases of the osteoarticular system ; Human ; Treatment ; Clinical trial ; Paracetamol ; Celecoxib ; Rofecoxib ; Knee ; Joint ; Arthritis ;

Mots-clés français / French Keywords

Chimiothérapie ; Membre inférieur ; Arthropathie ; Système ostéoarticulaire pathologie ; Homme ; Traitement ; Essai clinique ; Paracétamol ; Célécoxib ; Rofécoxib ; Genou ; Articulation ; Arthrite ;

Mots-clés espagnols / Spanish Keywords

Quimioterapia ; Miembro inferior ; Artropatía ; Sistema osteoarticular patología ; Hombre ; Tratamiento ; Ensayo clínico ; Paracetamol ; Celecoxib ; Rofecoxib ; Rodilla ; Articulación ; Artritis ;

Localisation / Location

INIST-CNRS, Cote INIST : 5051, 35400009989675.0090