Brooks and Kubler of the hip or knee should be considered an adjunct to that etoricoxib has at least comparable efficacy and greater nonpharmacologic strategies including patient education, gastrointestinal tolerability compared with nonselective personalized social support, weight loss, and appropriate NSAIDs, and may therefore be particularly suitable for physical activity (ACRSOG 2002). COX-2 inhibitors are patients with gastrointestinal risk factors. Results from the considered useful among patients who do not achieve MEDAL Program will provide further insight into the symptom relief with acetaminophen, and in those where efficacy and gastrointestinal, renovascular, and adverse events to acetaminophen or nonselective NSAIDs cardiovascular tolerability of etoricoxib. In summary, are likely or have occurred (ACRSOG 2002). Analgesics, etoricoxib provides an effective therapeutic alternative in including selective COX-2 inhibitors, are an important the management of arthritic and painful conditions. As for component of the management of a variety of other all drugs, the benefits and risks of treatment should be musculoskeletal pain syndromes (Argoff 2002). Etoricoxib, like all COX-2 inhibitors, may be associated with a small increase in the risk of some cardiovascular adverse events, and this needs to be weighed carefully against the benefits of treatment, particularly in patients with underlying cardiovascular risk factors. European etoricoxib prescribing guidelines indicate that treatment is contra- indicated in patients with congestive heart failure, poorly controlled hypertension, established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease. The treatment should be given for the shortest duration possible at the lowest effective daily dose, and the need for and response to treatment should be reevaluated periodically (EMEA 2005a). This is in line with US guidelines for all prescription and nonprescription NSAIDs (excluding aspirin) (FDA 2005d). Economic evaluation in the UK showed that etoricoxib was a cost-effective option in patients with RA or OA compared with nonselective NSAIDs plus gastroprotective therapy (proton pump inhibitors or misoprostol) (Moore et al 2004). It was also cost effective compared with nonselective NSAIDs in patients with AS in the UK (Jansen et al 2005). Etoricoxib is associated with higher treatment costs than indomethacin for acute gouty arthritis, but this may be counterbalanced by indirect cost savings and improved quality of life due to fewer drug-related adverse effects (Martin et al 2005). Conclusion A clinical summary for etoricoxib is presented in Figure 4. Etoricoxib is a COX-2 inhibitor with a high degree of selectivity for its target. It provides an alternative to other selective and traditional NSAIDs in treating patients with arthritis and other painful conditions. Etoricoxib may be given to a broad range of patients without need for dosage adjustment, except in cases of hepatic insufficiency. It is suitable for once-daily administration, which may facilitate patient compliance with treatment. Clinical trials have shown 54 evaluated carefully for each patient. Abbreviations ACR, American College of Rheumatology; ACR20, American College of Rheumatology 20% Response Criteria; AS, ankylosing spondylitis; BID, twice daily; CI, confidence interval; COX, cyclooxygenase; CYP, cytochrome P450; DMARD, disease-modifying antirheumatic drug; EDGE, Etoricoxib versus Diclofenac sodium Gastrointestinal tolerability and Effectiveness study; EMEA, European Medicines Agency; FDA, United States Food and Drug Administration; IC50, inhibitory concentration of 50%; LBP, low back pain; MEDAL, Multinational Etoricoxib and Diclofenac Arthritis Long-term study; NSAID, nonsteroidal anti- inflammatory drug; OA, osteoarthritis; PGADS, patient’s global assessment of disease status; QD, once daily; RA, rheumatoid arthritis; RR, relative risk; TID, three times daily; WOMAC, Western Ontario and McMaster’s University OA index. References Agrawal NG, Matthews CZ, Mazenko RS, et al. 2004a. Pharmacokinetics of etoricoxib in patients with renal impairment. 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