Abstract
The international multicenter PRECISION study evaluating the cardiovascular safety of celecoxib, naproxen, and ibuprofen is under close scrutiny by critics. One of the criticisms about this study was that the use of relatively low dose (on average just above 200 mg/day) may not be effective enough. But is it really so? This review gives data from numerous international studies dealing with the treatment of osteoarthritis (OA), in which celecoxib 200 mg/day is compared with paracetamol 4000 mg/day, diclofenac 100—150 mg/day, naproxen 1000 mg/day, ibuprofen 2400 mg/day and slow-acting antirheumatic drugs (glucosamine, chondroitin, and their combination). Almost all studies demonstrate that celecoxib 200 mg has a good and rapid analgesic effect that is not inferior to or exceed that of the reference drugs. Celecoxib 200 mg/day could relieve pain in OA for many months and prevent disease recurrences. The low risk of gastrointestinal and cardiovascular complications, which has been confirmed by the PRECISION study, makes celecoxib 200 mg/day the drug of choice for long-term OA therapy, including in patients with serious comorbid conditions.
Highlights
How effective is the average therapeutic dose of a nonsteroidal anti-inflammatory drug in osteoarthritis? Karateev A.E
The international multicenter PRECISION study evaluating the cardiovascular safety of celecoxib, naproxen, and ibuprofen is under close scrutiny by critics
One of the criticisms about this study was that the use of relatively low dose may not be effective enough. Is it really so? This review gives data from numerous international studies dealing with the treatment of osteoarthritis (OA), in which celecoxib 200 mg/day is compared with paracetamol 4000 mg/day, diclofenac 100–150 mg/day, naproxen 1000 mg/day, ibuprofen 2400 mg/day and slow-acting antirheumatic drugs
Summary
[34] провели 6-месячное исследование эффективности постоянного приема целекоксиба 200 мг/сут и его приема в режиме «по требованию» у 858 больных ОА коленного сустава. При этом число НР в группе постоянного приема целекоксиба не нарастало. Справедливости ради нужно заметить, что при сравнении с максимальной суточной дозой других НПВП (например, диклофенака) целекоксиб 200 мг/сут не всегда проявлял равное терапевтическое действие. [35] провели 12-недельное сравнение эффективности целекоксиба 200 мг 1 раз в день и диклофенака 50 мг 3 раза в день у 249 больных с тяжелым ОА тазобедренного сустава. [37], в котором сравнили действие напроксена 1000 мг/сут, целекоксиба 400, 200 и 100 мг/сут и плацебо у 1061 больного ОА тазобедренного сустава. При этом наибольшее уменьшение средней интенсивности боли отмечалось при использовании целекоксиба 200 мг/сут При этом наибольшее уменьшение средней интенсивности боли отмечалось при использовании целекоксиба 200 мг/сут (рис. 2)
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