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Etodolac and naproxen for gout

 

Clinical bottom line

In two small studies etodolac 600 mg daily was equally as effective as naproxen (500 mg twice or three times a day) in the treatment of acute gout


Reference

R Lederman. A double-blind comparison of etodolac and high doses of naproxen in the treatment of acute gout. Advances in Therapy 1990 7:344-354.

A Maccagno et al. Effectiveness of etodolac compared with naproxen in patients with acute gout. Current Medical Research and Opinion 1991 12: 423-429.

Studies

The two studies were randomised, and one may have been double blind. They compared 300 mg etodolac twice a day with 500 mg naproxen twice or three times a day. Details of the studies are in Table 1.

Table 1: Details of studies found

Reference Design Included patients Outcomes Results
Lederman, 1990
Quality score 1/5
Randomised, double-blind, parallel-group with 300 mg etodolac twice a day (29) or naproxen 500 mg three times a day (31) for three to seven days. Note, no mention of identical placebos or double dummy, so trial may not have been truly double blind. Age 18-75 with acute pain, tenderness, redness and heat in a single joint for less than 48 hours. Confirmed diagnosis, two previous episodes, urate crystals in synovial fluid categorical scales for patient and physician overall rating, pain, swelling, erythema, tenderness, motion and heat. Patients matched at baseline, except etodolac group had more severe gout. Improvement at end of treatment by 93% with etodolac and 87% with naproxen. Most improvement over first two days
Maccagno et al, 1991
Quality score 2/5
Randomised, double-blind, parallel-group with 300 mg etodolac (31) twice a day or naproxen 500 mg twice daily (30) for seven days. Age 18-75 with acute pain, tenderness, redness and heat in a single joint for less than 48 hours. Confirmed diagnosis, two previous episodes, urate crystals in synovial fluid categorical scales for patient and physician overall rating, pain, swelling, erythema, tenderness, motion and heat. Patients matched at baseline, except etodolac group had more severe gout. Etodolac claimed better than naproxen at some measures on days two and four, but not consistently. More than 90% in each group had improvement during the study.

Results

These were the only two studies that could be found. They showed that these two NSAIDs improved pain and other symptoms of acute gout over two to four days.

Comment

The trials are small, but outcomes useful. The total number of patients is about 120, studied over three to seven days. Demonstrating any difference would be extremely unlikely. Most of the patients had improved over seven days, and at four days, with significant numbers improved by the second day of treatment.