The Effects of Aceclofenac and Nabumetone in Osteoarthritis

Abstract

Introduction: Aceclofenac, a NSAID is widely used in the treatment of pain and infl ammation
associated with osteoarthritis. Nabumetone, a recently developed preferential cyclo-oxygenase 2
inhibitor has also proved to be equally effective. The present study was undertaken to evaluate the
‘real better’ drug, amongst these with better effi cacy and gastro-intestinal tolerability as well.
Methods:Four hundred and twenty-three patients of either sex, aged 40-64 years with uncomplicated
osteoarthritis of knee joint were randomly allocated into three equal groups receiving aceclofenac,
nabumetone or placebo. A baseline pain measurement was done with Visual Analogue Scale (VAS:
0-10 scale) and Investigator Global Assessment of Disease status (IGADS: 0-4 point scale). Code was
broken at the end of two weeks or earlier to eliminate any real fatal outcome. Final evaluation of
efficacy was done at the end of four weeks. The signifi cance of difference between the treatment
outcomes was analyzed using one way ANOVA test.
Results:During the active comparator controlled period, the most common reason for discontinuation
was unacceptable adverse events. While 108 (76.6%) participants could take the full course of treatment
with aceclofenac, 118 (83.7 %) of the nabumetone group completed the study. Drop outs were highest
in the placebo group (33.9%) followed by the aceclofenac group (12.1%) and nabumetone group
(8.5%). Discontinuation due to G.I. intolerance was least in the placebo group (2.1%) followed by the
nabumetone group (5%) and aceclofenac group (7.8%).
Conclusions:The preferential inhibition of cyclo-oxygenase 2 by nabumetone was postulated
to afford better clinical effi cacy and gastrointestinal tolerability in osteoarthritis as compared to
aceclofenac.
Key Words: aceclofenac, nabumetone, osteoarthritis