title: Efficacy of cyclo-oxygenase-2 inhibition by etoricoxib and naproxen on the axial manifestations of ankylosing spondylitis in the presence of peripheral arthritis MRI and clinical findings in patients with ankylosing spondylitis eligible for anti-tumour necrosis factor therapy after a short course of etoricoxib Longitudinal Numbers-Needed-To-Treat (NNT) for Achieving Various Levels of Analgesic Response and Improvement with Etoricoxib, Naproxen, and Placebo in Ankylosing Spondylitis [Etoricoxib in the treatment of active sacroiliitis in patients with axial spondyloarthritis, including ankylosing spondylitis]. Etoricoxib in ankylosing spondylitis: is there a role for active patients refractory to traditional NSAIDs?
abstract: Objective : The combined efficacy of selective and non-selective cyclo-oxygenase-2 ( COX-2 ) inhibition on the axial manifestations of ankylosing spondylitis ( AS ) in the presence or absence of chronic peripheral arthritis was evaluated . Methods : In a post hoc subgroup analysis of a 6 week , r and omised , double blind , placebo controlled trial , 387 patients with active axial AS were r and omised to receive etoricoxib 90 mg or 120 mg once a day , naproxen 500 mg twice daily , or placebo . R and omisation was stratified by the presence or absence of chronic peripheral arthritis . The primary outcome measure was the time weighted average change from baseline of spine pain intensity . Efficacy data from the three groups receiving active treatment ( the NSAID/COX-2 inhibitor group ) were combined to improve precision . An analysis of covariance model was used to evaluate the effect of peripheral disease on treatment response . Results : 93 patients were allocated to receive placebo and 294 to active treatment ( naproxen or etoricoxib ) . The combined NSAID/COX-2 inhibitor group had a significant treatment response compared with the placebo group for all efficacy measures , both in patients with and without peripheral arthritis . A significantly greater difference in mean patient assessment of spine pain was found between active and placebo treatments in patients without compared with those with peripheral arthritis ( p = 0.005 ; −32.5 mm v −17.0 mm , respectively ) . Similar differences , although not statistically significant , were seen for other end points . Conclusion : NSAIDs and COX-2 inhibitors have a clinical ly relevant symptomatic effect on axial AS irrespective of the presence of peripheral arthritis . In this exploratory analysis spinal improvement appeared to be greater in patients without peripheral disease Objective : To describe and assess the response to short-term etoricoxib as shown by MRI and clinical variables in patients with ankylosing spondylitis ( AS ) selected for eligibility for anti-tumour necrosis factor therapy .  Methods : In a 6-week open-label study , 22 patients with AS and eligible for biological therapy were treated with 90 mg of etoricoxib daily . Clinical and laboratory parameters were obtained and MRI of the sacroiliac joints and the lower thoracic and lumbar spine performed at baseline and at week 6 . The primary end point was the proportion of patients fulfilling the SpondyloArthritis international Society ( ASAS ) response criteria for biological therapies ( ASASBIO ) while secondary end points included the change in MRI-determined bone lesions . Results : Eight of 20 completers improved enough to meet the ASASBIO response criteria and most clinical variables improved significantly . Fifteen patients had a total of 63 MRI-detectable lesions ; overall , 13/60 lesions with paired scans either resolved completely or improved , while five lesions worsened or appeared during treatment . Conclusion : Etoricoxib is an effective symptomatic treatment for patients with AS ; however , its effect on MRI-detected lesions is small . Further studies are needed to determine the effect of etoricoxib on MRI-determined bone oedema Background Clinical analgesic trials typically report response as group mean results . However , research has shown that few patients are average and most have responses at the extremes . Moreover , group mean results do not convey response levels and thus have limited value in representing the benefit-risk at an individual level . Responder analyses and numbers-needed-to-treat ( NNT ) are considered more relevant for evaluating treatment response . We evaluated levels of analgesic response and Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) score improvement and the associated NNTs . Methods This was a post-hoc analysis of a 6-week , r and omized , double-blind study ( N = 387 ) comparing etoricoxib 90 mg , etoricoxib 120 mg , naproxen 1000 mg , and placebo in AS . Spine pain and BASDAI were measured on a 100-mm visual analog scale . The number and percentage of patients achieving ≥30 % and ≥50 % improvement in both BASDAI and spine pain were calculated and used to determine the corresponding NNTs . Patients who discontinued from the study for any reason were assigned zero improvement beyond 7 days of the time of discontinuation . Results For etoricoxib 90 mg , etoricoxib 120 mg and naproxen 1000 mg , the NNTs at 6 weeks compared with placebo were 2.0 , 2.0 , and 2.7 respectively for BASDAI ≥30 % improvement , and 3.2 , 2.8 , and 4.1 for ≥50 % improvement . For spine pain , the NNTs were 1.9 , 2.0 , and 3.2 , respectively , for ≥30 % improvement , and 2.7 , 2.5 , and 3.7 for ≥50 % improvement . The differences between etoricoxib and naproxen exceeded the limit of ±0.5 units described as a clinical ly meaningful difference for pain . Response rates and NNTs were generally similar and stable over 2 , 4 , and 6 weeks . Conclusions For every 2 patients treated with etoricoxib , 1 achieved a clinical ly meaningful ( ≥30 % ) improvement in spine pain and BASDAI beyond that expected from placebo , whereas the corresponding values were approximately 1 in every 3 patients treated with naproxen . Use of NNTs and responder analyses provide additional , complementary information beyond population mean responses when assessing efficacy compared to placebo and amongst active therapies AIM To study a trend in active sacroiliitis ( ASI ) in patients with axial spondyloarthritis ( axSpA ) during different short-term regimens using etoricoxib ( ET ) 90 mg . SUBJECTS AND METHODS Forty patients with axSpA , including 30 with ankylosing spondyloarthritis ) , and ASI ( sacroiliac joint ( SIJ ) osteitis as evidence d by magnetic resonance imaging ) were examined and then r and omized to 2 groups : 1 ) 20 patients who took ET 90 mg four days or more a week ; 2 ) 20 patients who received ET 90 mg 3 days or less a week .  Osteitis was measured in 4 quadrants of each SIJ ( 0 - 3 scores ) . Its main criterion was considered to be a decrease in total osteitis activity ( TOA ) 12 week later . RESULTS In all the patients ( n = 40 ) , TOA decreased from 6.5 ( 4 ; 9 ) to 2 ( 0 ; 5 ) scores ( p < 0.0001 ) . In Group 1 ( n = 20 ) , that reduced from 6.5 ( 4 ; 8.5 ) to 0 ( 0 ; 3 ) scores ( p < 0.0001 ) . In Group 2 ( n = 20 ) , that did from 6.5 ( 4 ; 10 ) to 4 ( 1 ; 8) scores ( p = 0.49 ) . At 12 weeks , in in Groups 1 and 2 , the difference in final TOA achieved no statistical significance ( p=0.056 ) . In these groups , there were 19 ( 95 % ) and 14 ( 70 % ) treatment-responsive patients , respectively . CONCLUSION The intake of ET 90 mg for 12-weeks is associated with a reduction in the degree of ASI in patients with axSpA. The use of ET 4 times or more a week is more effective in diminishing osteitis than that of ET 3 days or less OBJECTIVES To evaluate the efficacy of etoricoxib in patients with axial ankylosing spondyloarthritis ( AS ) refractory to traditional NSAIDs . METHODS This was an open label , multicentric , r and omised , prospect i ve ( 4 weeks with and open extension to 6 months ) , non-controlled study . Consecutive patients with axial AS refractory to traditional NSAID eligible for anti-TNF-α therapy were selected . The primary outcomes were the rate of patients with good clinical response ( not eligible for anti-TNF-α therapy after etoricoxib ) and the Assessment of Spondyloarthritis International Society response criteria for biologic therapies ( ASASBIO ) response at 4 weeks . Secondary outcomes included : ASAS20 and 40 responses , ASDAS-CRP response , BASDAI , BASFI , back and night back pain , global patient and physician assessment of the disease , and biologic parameters like C-reactive protein ( CRP ) at 2 , 4 weeks and 6 months . RESULTS A total of 57 axial AS patients were recruited , 46 men , with mean age of 43 years . After 4 weeks of treatment , 26 patients ( 46 % ) achieved a good clinical response and 11 ( 20 % ) an ASASBIO response . These results at 24 weeks were 19 ( 33 % ) and 13 ( 23 % ) respectively . All individual clinical variables improved significantly after 4 weeks of treatment . CRP serum levels decreased after 4 weeks but reached no statistical significance , although 30 % of patients showed a normalisation of CRP . CONCLUSIONS Etoricoxib provided a clear clinical improvement in around a third of patients with axial AS refractory to traditional NSAIDs . Special care should be required when deciding to start anti-TNF-α therapy ; it seems reasonable to keep in mind these results of etoricoxib treatment
target: Results : This systematic review will provide a detailed summary of present evidence related to the efficacy and safety  of etoricoxib for patients with AS .
  Conclusion : The results of this study may provide management guidance for AS treated by etoricoxib .
background: Background : Previous clinical trials have reported that etoricoxib has been utilized to treat ankylosing spondylitis ( AS ) effectively .
  However , no study systematic ally investigated the efficacy and safety of etoricoxib for patients with AS .
  In this systematic review , we will assess the efficacy and safety of etoricoxib for AS .