Clinical trial of tolmetin and aspirin in the treatment of rheumatoid arthritis

A double-blind crossover, within-patient trial was conducted, to compare the efficacy of tolmetin (Tolectin; Ethnor) with that of aspirin in the treatment of rheumatoid arthritis. Tolmetin significantly improved morning stiffness (P less than 0.01), while aspirin was superior in reducing the number of painful joints (P less than 0.001) and the articular index (P less than 0.01). Tolmetin, in marked contrast to aspirin, was well tolerated, producing virtually no side-effects. An elevation of the alkaline phosphatase was noted in 4 patients on tolmetin therapy. When used after aspirin, tolmetin had a significantly adverse effect on the erythrocyte sedimentation rate (P less than 0.05). The results of this study indicate that tolmetin is a useful addition to the therapeutic agents for the treatment of rheumatoid arthritis, because of its ability to reduce morning stiffness and its lack of side-effects.

A comparison of tolmetin with aspirin in the treatment of osteo-arthritis of the knee

A randomized, double-blind crossover study conducted on 55 patients showed tolmetin (Tolectin; Ethnor) (900 mg daily) to be as effective as aspirin (4 500 mg daily) in relieving the symptoms and signs of osteo-arthritis of the knee. Overall, aspirin produced significantly more side-effects, but the incidence of gastro-intestinal side-effects did not differ significantly. In almost every comparison tolmetin had the better score, but differences were not statistically significant; the only exception was the evaluation of the patients' well-being at mid-therapy, which significanlty favoured tolmetin.

New antirheumatic agents: Fenoprofen calcium (Nalfon), naproxen (Naprosyn), and tolmetin sodium (Tolectin)

The new antirheumatic agents, fenoprofen calcium, naproxen, and tolmetin sodium, are effective in the management of rheumatoid arthritis. Their efficacy is comparable, but not superior, to that of aspirin in usual oral doses. These agents also may be useful in degenerative joint disease and ankylosing spondylitis and as analgesics and antipyretics; however, there are insufficient data available to establish their efficacy and dosages for these uses. The incidence of adverse reactions, including gastrointestinal bleeding, is lower with these agents than with aspirin; thus, these drugs may be useful substitutes in patients who cannot tolerate the gastrointestinal effects of aspirin.

Tolmetin sodium, a new anti-arthritis drug: double-blind and long-term studies

The effectiveness of tolmetin sodium in the treatment of rheumatoid arthritis was evaluated by: 1) a 12-week, double-blind study with a dosage range of 800-1600 mg daily; and 2) an open 2-year study with a dosage range of 400-2400 mg daily. The double-blind study involved 14 patients (7 tolmetin sodium, 7 placebo), and the long-term study involved 24 patients. At frequent intervals, evaluations were made of joint pain, swelling, stiffness and inflammation; grip strength; walking time; and subjective well-being. Various laboratory tests were also performed. In the double-blind study, tolmetin sodium proved superior to placebo and produced moderate improvement. In the long-term study, 5 patients improved markedly, 14 moderately, and 3 minimally. Severe side effefts were notably absent. Some mild side effects occurred but they were transient and did not interfere with therapy. Tolmetin sodium seems effective and safe in the management of rheumatoid arthritis.

Treatment of rheumatoid arthritis with tolmetin: a comparison with alclofenac

A double-blind between-patient trial over 6 weeks to compare the effects of 1.6 g tolmetin daily with 4 g alclofenac daily was completed by 37 out of 44 out-patients with rheumatoid arthritis. Tolmetin proved as effective as alclofenac in relieving pain and in reducing both the articular index score and the number of inflamed joints. However, alclofenac produced a significantly greater reduction in the duration of morning stiffness, which could have been related to the timing of the initial daily dose of tolmetin. Onset of fatigue was significantly improved by both drugs. Neither treatment group exhibited any significant changes in the serum levels of IgG, IgA, and IgM, nor in the latex and sheep-cell agglutination titres. Although neither drug gave rise to serious side-effects, 3 patients (2 on tolmetin, 1 on alclofenac) were withdrawn because of skin rash, 2 (on tolmetin) because of gastro-intestinal upsets, and 1 from each group because of lack of analgesic effects.

A double-blind crossover comparison of tolmetin sodium and phenylbutazone in the treatment of rheumatoid arthritis

A double-blind crossover study was carried out in 24 patients with rheumatoid arthritis to investigate the relative efficacy of tolmetin (1600 mg/day) and phenylbutazone (400 mg/day). Each drug was given for 4 weeks, preceded by a 2-week wash-out period during which patients received paracetamol alone for pain relief. Assessments were made of duration of morning stiffiness, grip strength, articular index, joint size, and degree of pain. Both drugs produced significant improvements compared to paracetamol, particularly in pain relief and, apart from morning stiffness, tolmetin proved equally effective as phenylbutazone. Three patients (2 on tolmetin and 1 on phenylbutazone) were withdrawn because of side-effects. In general, however, both drugs gave rise to only minor side-effects.

Evaluation of tolmetin in the treatment of arthritis: open and controlled double-blind studies

In a 6-week open study in 24 patients with rheumatoid arthritis, tolmetin was shown to have analgesic and anti-inflammatory activity at daily doses in excess of 1200 mg per day and produced statistically significant reductions in overall joint pain, walking time and articular index. The drug was well tolerated, but 2 patients were withdrawn because of persistent indigestion and 1 because of an urticarial type rash. In a double-blind crossover comparison against indomethacin and placebo in 22 patients, 1400 mg tolmetin daily showed efficacy comparable with that of 150 mg indomethacin daily. Few side-effects were reported and did not necessitate any patients being withdrawn.