R E V I E W Etoricoxib for ar thritis and pain management Peter Brooks1 Paul Kubler2 1Executive Dean (Health Sciences), Edith Cavell Building, Royal Brisbane Hospital, Queensland, Australia; 2Staff Specialist Clinical Pharmacology/Rheumatology, Royal Brisbane Hospital & Royal Women’s Hospital and Health Service Districts, Brisbane, Queensland, Australia Correspondence: Peter Brooks Executive Dean (Health Sciences), Edith Cavell Building, Royal Brisbane Hospital, Queensland QLD 4029, Australia Tel +61 7 3365 5106 Fax +61 7 3365 5533 Email p.brooks@mailbox.uq.edu.au Abstract: Nonsteroidal antiinflammatory drugs (NSAIDs), including selective cyclooxygenase (COX)-2 inhibitors, have come to play an important role in the pharmacologic management of arthritis and pain. Clinical trials have established the efficacy of etoricoxib in osteoarthritis, rheumatoid arthritis, acute gouty arthritis, ankylosing spondylitis, low back pain, acute postoperative pain, and primary dysmenorrhea. Comparative studies indicate at least similar efficacy with etoricoxib versus traditional NSAIDs. Etoricoxib was generally well tolerated in these studies with no new safety findings during long-term administration. The gastrointestinal, renovascular, and cardiovascular tolerability profiles of etoricoxib have been evaluated in large patient datasets, and further insight into the cardiovascular tolerability of etoricoxib and diclofenac will be gained from a large ongoing cardiovascular outcomes program (MEDAL). The available data suggest that etoricoxib is an efficacious alternative in the management of arthritis and pain, with the potential advantages of convenient once-daily administration and superior gastrointestinal tolerability compared with traditional NSAIDs. Keywords: etoricoxib, cyclooxygenase-2, nonsteroidal antiinflammatory drugs, arthritis, pain Introduction Musculoskeletal conditions are often progressive and associated with considerable pain and disability (WHO 2005). These conditions place a huge burden on society in terms of lost productivity and the cost of treatment (WHO 2005). Rheumatoid arthritis (RA), osteoarthritis (OA), and spinal disorders (including chronic low back pain [LBP]) are among those musculoskeletal conditions with the greatest impact on society (WHO 2005). Approximately 14% of all primary care visits are for musculoskeletal pain or dysfunction (ACRCCG 1996). Symptomatic OA affects approximately 10% of men and 18% of women over 60 years of age (WHO 2005), while RA affects between 0.3% and 1% of adults worldwide (WHO 2005). Approximately 2.0% of all disability-adjusted life years are lost due to musculoskeletal diseases, including 1.0% due to OA, and 0.3% due to RA (WHO 2004). Current approaches to the management of these conditions are many and varied, but pharmacologic intervention is usually required at some stage for relief of acute or chronic pain and inflammation. In patients with RA, treatment with nonsteroidal antiinflammatory drugs (NSAIDs) is usually required as part of initial drug therapy, alongside disease-modifying antirheumatic drugs (DMARDs), and/or glucocorticoids (ACRRAG 2002). Pharmacologic intervention in patients with OA, as an adjunct to nonpharmacologic strategies, may include the use of acetaminophen or NSAID therapy (ACRSOG 2002). Analgesic drugs, including NSAIDs, also play a regular role in the management of other chronic musculoskeletal pain syndromes such as low back pain and ankylosing spondylitis, and in other painful conditions including postsurgical dental pain and headache (Argoff 2002). Selective cyclooxygenase (COX)-2 inhibitors, a subclass of NSAIDs, continue to have a place in the management of RA and OA (ACRRAG 2002; ACRSOG 2002; Therapeutics and Clinical Risk Management 2006:2(1) 45– 57 © 2006 Dove Medical Press Limited. All rights reserved 45