Abstract
To study nabumetone (1,000 mg once daily) by comparison with piroxicam (20 mg once daily) in patients with osteoarthritis, a randomized, double-blind trial was set up in 40 general practices. Evaluation was based on clinical outcome in 198 patients. There was some evidence that nabumetone is associated with a lower and less severe occurrence of gastric pain, and with more withdrawals due to lack of efficacy. Although the differences between nabumetone and piroxicam were small in this study, these were clinically relevant. The general practitioner should balance the respective benefits of greater safety and tolerance against greater efficacy in meeting the requirements of an individual patient with osteoarthritis.
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References
Scott JC, Hochberg MC. Osteoarthritis I: epidemiology. Maryland State Med J 1984;33:712–6.
Wood PHN, Badley E. Rheumatic disorders. In: Miller DL, Farmer RTD, eds. Epidemiology of diseases. Oxford: Blackwell Scientific Publications, 1982:333–46.
Voorn ThB. Chronische ziekten in de huisartspraktijk [Chronic diseases in general practice]. Utrecht: Wetenschappelijke uitgeverij Bunge, 1983.
Lamberts H. Morbidity in general practice: diagnosis related information from the monitoring project. Utrecht: Uitgeversmaatschappij Huisartsenpers, 1984.
De Bock GH, Kaptein AA, Mulder JD. Dutch general practitioner's management of patients with distal osteoarthritis symptoms. Scand J Prim Health Care 1992;10:42–6.
Baum C, Kennedy DL, Forbes MB. Utilization of non-steroidal anti-inflammatory drugs. Arthritis Rheum 1985; 28:686–92.
Leufkens HG, Ameling CB, Hekster YA, Bakker A. Utilization patterns of non-steroidal anti-inflammatory drugs in an open Dutch population. Pharm Weekbl [Sci] 1990;125:97–103.
Committee on the Safety of Medicines. CSM update: non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions 1. BMJ 1986;292:614.
Vermeulen HN, Stricker BHCh, De Koning GHP, Porsius AJ. Een vergelijking van de meldingen van vermoedelijke bijwerkingen bij een regionaal en een landelijk meldings-systeem [A comparison of reported suspected adverse drug reactions between a regional centre and a national centre]. Pharm Weekbl 1990;125:931–6.
Bradly JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an anti-inflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991;325:87–91.
Steele K, Gilliland D. Non-steroidal anti-inflammatory drugs — prescribe with caution. J R Coll Gen Pract 1988;38:49–52.
Altman RD. Overview of osteoarthritis. Am J Med 1987;83:65–9.
Robinson DR. Management of gastrointestinal toxicity of non-steroidal anti-inflammatory drugs during the therapy of rheumatic diseases. Am J Med 1988;84:1–4.
Roth SJ. Endoscopy controlled study of the safety of nabumetone compared with naproxen in arthritis therapy. Am J Med 1987;30(4B):25–30.
Greb WH, Von Schrader HW, Cerlek S, Dominis M, Hauptmann E, Zenic N. Endoscopic studies of nabumetone in patients with rheumatoid arthritis. A comparative endoscopic and histologic evaluation. Am J Med 1987;30(4B): 19–24.
Lussie A, Le Bel E. Radiochromium (chromium-51) evaluation of gastrointestinal blood loss associated with placebo, aspirin, and nabumetone. Am J Med 1987;30(4B):15–8.
Pocock SJ. Clinical trials: a practical approach. Chichester: John Wiley & Sons, 1983.
Bulpitt CJ. Randomised controlled clinical trials. The Hague: Martinus Nijhoff Publishers, 1983.
Mangan FR. Nabumetone. In: Lewis AJ, Furst DE, eds. Non-steroidal anti-inflammatory drugs: mechanism and clinical use. New York: Marcel Dekker, 1987:439–72.
Lombardino JG, Wiseman EH. Piroxicam. In: Lewis AJ, Furst DE, eds. Non-steroidal anti-inflammatory drugs: mechanism and clinical use. New York: Marcel Dekker, 1987:487–508.
Kraemer HCh, Thiemann S. How many subjects? Statistical power analysis in research. Newbury Park: SAGE Publications, 1987.
The Classification Committee of WONCA (World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians) in collaboration with the World Health Organization. ICHPPC-2-Defined (International Classification of Health Problems in Primary Care). Oxford: Oxford University Press, 1983.
Steinbrocker O, Traeger CH, Batterman RC. Therapeutic criteria in rheumatoid arthritis. JAMA 1949; 140:659–62.
Fok KH, George PJM, Vicary FR. Peptic ulcer induced by piroxicam. BMJ 1985;290:117.
Rossi AC, Hsu JP, Faich JP. Ulcerogenicity of piroxicam: an analysis of spontaneously reported data. BMJ 1987;294: 1479–50.
Committee on Safety of Medicines. CSM update: non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions 2. BMJ 1986;292:1190–1.
Schellevis FG, Van Weel C, Van der Velden J, Van de Lisdonk EH. Co-morbidity of chronic diseases in general practice. In: International conference doctors at work: general practice in facts and figures. Utrecht: Netherlands Institute of Primary Health Care, 1990.
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De Bock, G.H., Hermans, J. & Mulder, J.D. Randomized double-blind study of nabumetone and piroxicam in the treatment of osteoarthritis in Dutch general practice: efficacy and tolerability. Pharm World Sci 15, 132–138 (1993). https://doi.org/10.1007/BF02113942
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DOI: https://doi.org/10.1007/BF02113942