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セレコキシブとディクロフェナックによるリウマチ性関節炎の長期的な管理:ランダム化によるダブルブラインド比較
P Emery1, H Zeidler, T K Kvien
1Department of Rheumatology and Rehabilitation, University of Leeds, UK.
Lancet (London, England)
|December 28, 1999
まとめ
セレコキシブは,リウマチ性関節炎患者において,ディクロフェナックと同等の抗炎症効果と痛みを和らげる効果を示した. しかし,セレコキシブは,胃腸潰瘍と有害事象を著しく減少させ,よりよい耐受性を提供しました.
科学分野:
- レウマトロジーの病理学
- 薬理学 薬理学とは
- 胃腸内科 胃腸内科
背景:
- 非ステロイド性抗炎症薬 (NSAIDs) は,サイクロオキシゲナーゼ (COX) を阻害することによって,胃腸損傷を引き起こす可能性があります.
- セレコキシブは選択的にCOX-2を抑制し,ディクロフェナックはCOX-1とCOX-2の両方を抑制する.
- これらのNSAIDの比較胃腸安全性の理解は,長期的な患者管理に不可欠です.
研究 の 目的:
- 長期セレコキシブ療法とディクロフェナック療法の有効性,安全性,耐受性を比較する.
- 胃腸潰瘍の発生率と各薬に関連する有害事象を評価する.
- リウマチ性関節炎患者の抗炎症および鎮痛効果を評価する.
主な方法:
- 24週間のランダム化試験で,655人の成人レウマチ性関節炎患者を対象に実施した.
- 患者はセレコキシブ200mgを1日2回,またはディクロフェナックSR75mgを1日2回投与された.
- 胃腸の安全性は,上部胃腸内視鏡検査で評価され,効果と耐受性は,研究を通して監視されました.
主要な成果:
- 両薬とも,リウマチ性関節炎では同様の抗炎症および鎮痛効果を示した.
- セレコキシブ群 (4%) では,ディクロフェナック群 (15%) と比較して,ガストロドゥオデナル潰瘍が著しく少なく見られた.
- 胃腸関連の有害事象は,セレコキシブ患者の6%に対してディクロフェナック患者の16%で離脱を引き起こしました.
結論:
- セレコキシブは,ディクロフェナックに匹敵する持続的な抗炎症および鎮痛効果を提供します.
- セレコキシブ治療は,上部胃腸潰瘍と有害事象の発生率の低下と関連しています.
- セレコキシブは,リウマチ性関節炎患者の長期使用において,ディクロフェナックと比較して優れた耐受性を示しています.
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