Effects of etodolac on human chondrocytes cultivated in three dimensional culture

Comparison of Clinical Effectiveness and Safety of Newer Nonsteroidal Anti-inflammatory Drugs in Patients of Osteoarthritis of Knee Joint: A Randomized, Prospective, Open-label Parallel-group Study

OBJECTIVE:

Osteoarthritis (OA) is a chronic progressive degenerative disease of weight-bearing joints and the leading cause of disability in elderly. Current medical management of OA is mostly palliative with nonsteroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy. Reports of gastrointestinal adverse effects with traditional NSAIDs and cardiovascular adverse effects associated with selective cyclooxygenase-2 (COX-2) inhibitors have prompted the hunt for a better NSAID with no or minimal adverse effects. This study compares the clinical effectiveness and safety of newer NSAIDS etodolac and lornoxicam to diclofenac which has been a standard therapy in patients of OA of knee joint.

MATERIALS AND METHODS:

It was a randomized, prospective, open-label, parallel-group study conducted in 90 patients of OA of knee joint diagnosed according to the American College of Rheumatology criteria. After obtaining the informed consent, they were randomized in three groups of 30 patients each who received tablet etodolac 400 mg b.i.d, tablet lornoxicam 8 mg b.i.d, and tablet diclofenac sodium 50 mg t.i.d, respectively. The duration of the study was 12 weeks. Data were tabulated and analyzed using analysis of variance (ANOVA) test, and level of significance was determined by its P value.

RESULTS:

After 12 weeks of treatment, pain intensity and functional indices in terms of visual analog scale and Western Ontario and McMaster Universities Osteoarthritis score were significantly better (P < 0.05) in lornoxicam group as compared to etodolac or diclofenac group along with lesser rate of adverse effects.

CONCLUSION:

It was concluded that lornoxicam was more effective and better tolerated NSAID than etodolac and diclofenac in treatment of knee joint OA.

In vitro effects of meloxicam on metabolism in articular chondrocytes from dogs with naturally occurring osteoarthritis

OBJECTIVE

To assess effects of in vitro meloxicam exposure on metabolism in articular chondrocytes from dogs with naturally occurring osteoarthritis.

SAMPLE

Femoral head cartilage from 16 dogs undergoing total hip replacement.

PROCEDURES

Articular cartilage samples were obtained. Tissue sulfated glycosaminoglycan (SGAG), collagen, and DNA concentrations were measured. Collagen, SGAG, chondroitin sulfate 846, NO, prostaglandin E2 (PGE2), and matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, and MMP-13 concentrations in culture medium were analyzed. Aggrecan, collagen II, MMP-2, MMP-3, MMP-9, MMP-13, ADAM metallopeptidase with thrombospondin type 1 motif (ADAMTS)-4, ADAMTS-5, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, TIMP-3, interleukin-1β, tumor necrosis factor-α, cyclooxygenase-1, cyclooxygenase-2, and inducible nitric oxide synthase gene expression were evaluated. Comparisons between tissues cultured without (control) and with meloxicam at concentrations of 0.3, 3.0, and 30.0 μg/mL for up to 30 days were performed by means of repeated-measures analysis.

RESULTS

Meloxicam had no effect on chondrocyte SGAG, collagen, or DNA concentrations. Expression of ADAMTS-5 was significantly decreased in all groups on all days, compared with the day 0 value. On day 3, culture medium PGE2 concentrations were significantly lower in all meloxicam-treated groups, compared with values for controls, and values remained low. Culture medium MMP-3 concentrations were significantly lower on day 30 than on day 3 in all meloxicam-treated groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that in vitro meloxicam treatment of osteoarthritic canine cartilage for up to 30 days did not induce matrix degradation or stimulate MMP production. Meloxicam lowered PGE2 release from this tissue, and effects on tissue chondrocyte content and matrix composition were neutral.

Nonsteroidal anti-inflammatory drugs and corticosteroids for the management of canine osteoarthritis

Anti-inflammatory medications have long been prescribed for relief of the pain and discomfort associated with OA. This occurs despite the recognized side effects associated with use of NSAIDs and corticosteroids. Available evidence suggests that NSAIDs provide this relief through a combination of central and peripheral actions. Recent discovery of two isoforms of cyclooxygenase has increased our understanding of NSAID activity and may result in identification of drugs that potentially will have fewer side effects. A review of NSAIDs used in veterinary medicine indicates that relatively little is known regarding their role in treating OA, although controlled studies involving carprofen and etodolac have increased our knowledge of the efficacy of specific NSAIDs used for this purpose.

Active oxygen species, articular inflammation and cartilage damage

Rheumatoid arthritis and osteoarthritis are age-related diseases, in which degenerative changes (arthrosis) and superimposed inflammatory reactions (arthritis) lead to progressive destruction of the joints. Active oxygen species derived from various sources play a role in this process, which may be influenced by appropriate treatment with antioxidants and free radical scavengers.

Etodolac. A reappraisal of its pharmacology and therapeutic use in rheumatic diseases and pain states

Etodolac is a nonsteroidal anti-inflammatory drug (NSAID) effective in the treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, and in the alleviation of postoperative pain. Etodolac also provides relief of other types of pain, including that arising from gouty conditions and traumatic injury. In all indications, etodolac appears to be at least as effective as other NSAIDs. The incidence of clinical adverse effects other than abdominal pain and dyspepsia is similar to that observed with placebo, and etodolac has been associated with a low rate of gastrointestinal ulceration and other serious events. Data from preliminary animal studies have suggested that etodolac may provide more selective inhibition of prostaglandin synthesis at sites of inflammation than some other currently available NSAIDs. Thus, available evidence indicates that etodolac, with its low incidence of gastrointestinal events, is an effective and well tolerated alternative to other NSAIDs in the treatment of arthritic diseases and pain of various aetiologies and should be considered a first-line therapy.

Etodolac: efficacy in osteoarthritis and effects on chondrocyte function

Some nonsteroidal anti-inflammatory drugs (NSAIDs) used in the treatment of osteoarthritis (OA) may damage articular cartilage. This damage may be caused by suppression of proteoglycan synthesis or by altered collagen synthesis in the presence of prostaglandin E2 (PGE2) induced by interleukin-1 (IL-1). The clinical and biochemical effects of etodolac, a new NSAID, on the symptoms of OA and on cartilage metabolism are reviewed. Clinically, etodolac (200-600 mg/day) was more effective than placebo, and as effective as aspirin (3200-4800 mg/day), piroxicam (20 mg/day), naproxen (1000 mg/day), and diclofenac (150 mg/day) in relieving the symptoms of OA. In in vitro studies, proteoglycan synthesis was not affected by the presence of etodolac when human chondrocytes were grown in a three-dimensional culture. Etodolac preserved collagen phenotype in human chondrocytes cultured in a monolayer in the presence of IL-1. In contrast, the collagen phenotype of cells cultured in the presence of indomethacin and IL-1 changed. Under those conditions, less type II and type IX collagen were synthesized and more type I and type III collagen were synthesized. These findings suggest that etodolac, an effective agent in the treatment of OA, has the potential advantage of not damaging articular cartilage in vivo.

Recent clinical experience with etodolac in the treatment of osteoarthritis of the knee

Interim results are reported for three double-blind clinical trials comparing etodolac, a new nonsteroidal anti-inflammatory drug (NSAID), with piroxicam, diclofenac, or naproxen in patients with osteoarthritis (OA) of the knee. Patients assigned to receive etodolac were given 200 mg three times a day in the diclofenac comparison and 300 mg twice a day in the other two studies. The comparator groups in the three studies received piroxicam 20 mg once a day, diclofenac 50 mg three times a day, or naproxen 500 mg twice a day. The length of the studies ranged from 6 to 12 weeks, and patients were seen at baseline and every 2 weeks thereafter. Etodolac, piroxicam, and diclofenac treatment consistently resulted in similar and statistically significant changes from baseline, indicative of improvement, in all primary efficacy variables (physicians' and patients' global assessments of improvement, pain intensity, and night pain) at every evaluation. In the comparison with naproxen, patients who received etodolac showed statistically significant improvement at most evaluations, whereas significant changes were less frequent in the naproxen group. Response rates in the three studies (response was defined as a decrease of 1 or more units in the patient's overall global evaluation, which is based on a 5-point scale ranging from 1 = very good to 5 = very poor) were as follows: etodolac 72%, piroxicam 75%; etodolac 66%, diclofenac 56%; and etodolac 40%, naproxen 16%. These interim results suggest that the efficacy of etodolac compares favorably with that of other NSAIDs in the treatment of OA of the knee.

International experience with etodolac therapy for rheumatoid arthritis: an interim report of comparative efficacy

Etodolac, a nonsteroidal anti-inflammatory drug (NSAID) of the pyranocarboxylic acid family, has been tested in international clinical trials as a therapy for rheumatoid arthritis (RA). Preliminary results of 8- to 12-week double-blind trials indicate that etodolac therapy (200 mg twice a day) compared favorably with piroxicam therapy (20 mg once a day) and diclofenac therapy (50 mg three times a day) as measured by improvement in scores of five efficacy assessments: number of painful joints, number of swollen joints, physician's global assessment, patient's global assessment, and pain intensity. Etodolac also was as effective as naproxen (500 mg twice a day) as measured by improvement in scores in the five efficacy assessments. The observation that etodolac is as efficacious as three commonly used NSAIDs should interest clinicians who attempt to tailor NSAID therapy to the needs of individual RA patients, since etodolac has previously demonstrated an excellent safety profile. However, these trials must be completed to verify these preliminary results in a greater number of patients.