Professional Documents
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Slide V.1
Slide V.2
Slide V.3
Management
Gout is managed in the following 3 stages:
1. Treating the acute attack
2. Providing prophylaxis to prevent acute flares
3. Lowering excess stores of urate to prevent
flares of gouty arthritis and to prevent tissue
deposition of urate crystals
Slide V.4
Slide V.6
Classification of NSAIDs:
I. Non-selective COX inhibitors:inhibit the constitutive COX1 and the inducible COX-2 so are liable to be associated
with GIT upset and renal impairment on long term use. This
group is further classified according to chemical structure
into:
1) Salicylates e.g. acetyl salicylic acid.
2) Other NSAIDs:
a) Propionic acid derivatives e.g. Ibuprofen and
naproxen.
b) Oxicams
c) Aryl acetic acid derivatives e.g. Diclofenac.
d) Indole derivatives e.g. Indomethacin and
sulindac.
II. Selective COX-2 inhibitors: selectively inhibit COX2 and
are less liable to be associated with side effects, eg:
etoricoxib, celecoxib, rofecoxib, valdecoxib
Slide V.7
No. of patients
Year
28
18
47
30
24
20
33
29
93
10
43
59
60
61
150
1973
1978
1979
1979
1980
1983
1985
1986
1987
1987
1987
1988
1990
1991
2001
*List includes only double-blind clinical studies of oral agents based on extensive English-language Med Line literature search
(drug names and gout as search terms; no limit on year of publication; August 2002). All published double-blind clinical studies
may not be included.
Slide V.8
*Evaluated 4 hours after the initial dose and 4 hours after the morning dose on days 2 to 8.
Adapted from Schumacher HR Jr et al BMJ 2002;324:1488-1492.
Slide V.9
Etoricoxib 120 mg
(n=72)
Indomethacin 150 mg
(n=71)
LS mean ( SE)
0.5
1.0
1.5
2.0
2.5
3.0
R 4 hr
Day in study
Swelling**
0.0
0.0
0.5
1.0
1.5
2.0
2.5
0.5
1.0
1.5
2.0
2.5
Day in study
Etoricoxib 120 mg (n=74)
Day in study
Indomethacin 150 mg (n=73)
*03-point Likert scale (0 = no pain; 1 = patient states that there is pain; 2 = patient states that there is pain and winces;
3 = patient states that there is pain, winces, and withdraws)
**03-point Likert scale (0 = none, 1 = palpable, 2 = visible, 3 = bulging beyond joint margins)
LS = least squares; SE = standard error; R = randomization (baseline) visit
Adapted from Boice JA et al. Poster presented at the 3rd Annual European Congress of Rheumatology, 2002;
Data on file, MSD.
Slide V.11
89
83
78
Percent of patients
80
60
60
55
40
32
23
20
0
R
4 hr
Day in study
Etoricoxib 120 mg (n=74)
Indomethacin
(n=75)
%
22.7
46.7
0.0
1.3
2.7
9.3
0.0
1.3
% of Patients
With drug-related AEs*,**
AE = adverse events
*Prespecified for statistical testing
**p=0.003
Adapted from Schumacher HR Jr et al BMJ 2002;321:1488-1492; Data on file.
Slide V.13
Adverse Experiences*
Patients with one or more AE
Etoricoxib
(n=75)
%
Indomethacin
(n=75)
%
22.7
46.7
9.3
5.3
24.0
20.0
Cardiovascular
Hypertension
8.0
8.0
13.3
10.7
Digestive system
Nausea
8.0
0.0
22.7
6.7
Nervous system
Headache
Somnolence
2.7
1.3
1.3
12.0
6.7
5.3
Adapted from Schumacher HR Jr et al BMJ 2002;321:1488-1492; Boice JA et al. Poster presented at the 3rd Annual
European Congress of Rheumatology, 2002.
Slide V.15