Study Assessing the Efficacy of Etoricoxib in Female Patients With Fibromyalgia

August 9, 2012 updated by: Meir Medical Center

Study Proposal - A Randomized Double-blinded Study Comparing Adding Etoricoxib Versus Placebo to Female Patients With Fibromyalgia-analysis of Organic and Psychiatric Measures

The main of the proposed study is to assess whether the use of the Cox-2 inhibitor Etoricoxib is beneficial for the use in fibromyalgia. We intend to seek whether this medication may improve psychiatric and rheumatologic parameters of the disease.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

The fibromyalgia syndrome (FMS) is an ill-defined clinical disorder characterized by widespread pain and diffuse tenderness which is assessed at specified anatomical locations. The FMS is 10 times more common in females, and its prevalence in the community increases from two percent at age 20 to eight percent at age 70. Although the American College of Rheumatology (ACR) has defined classification criteria for the diagnosis of the FMS its' pathogenesis remains vague. Diffuse and persistent musculoskeletal pain, consistent with the mentioned ACR criteria have also been reported among patients with other ill defined medical conditions such as migraines, chronic fatigue pain, myofascial pain, irritable bowel syndrome which presentation often overlaps with the FMS.

There are mounting data supporting an overlap between the FMS and psychiatric conditions including depression, panic disorders and anxiety. For example, a lifetime history of major depression has been reported in 50% to 70% of patients with FMS and current depression was detected in 18% to 36% of patients with the FMS. This association has been questioned raising the possibility that this high prevalence reflects the long term outcome of coping with chronic disabling pain and disability.

Anti-depressants are the corner stone of therapy in FMS. Benzodiazepines and recent experience with melatonin has been implicated in order to alleviate sleep disturbances that are so often encountered among patients with this disorder. Nevertheless, patients with the FMS often need therapeutical medications in order to ease acute exacerbations of diffuse pain which are often provoked by mental or physical stressors.

Non-steroidal anti-inflammatory drugs (NSAIDs), COX-2-selective agents and acetaminophen are often used by a large number of FMS patients seeking a relief of acute pain. However, numerous studies have failed to confirm their effectiveness as analgesics in FMS, although there is limited evidence that patients may experience enhanced analgesia when treated with combinations of NSAIDs and other agents.

We believe that successful relief of diffuse pain may sever the bond tying pain and increased anxiety which is so characteristic in these patients. Furthermore, a clinical path that underlines the importance of pain relief may ensure the adherence and compliance that are needed to other elements of the therapeutical multidimensional approach in FMS and may be even improve psychiatric comorbidity that stem from the chronic non relenting pain.

A major factor limiting use of NSAIDs is concern for the development of gastrointestinal complications such as bleeding. COX-2 selective inhibitors were developed to decrease the risk of gastrointestinal tract injury and to avoid the anti-platelet effect of traditional NSAIDs. The recent MEDAL study has confirmed this finding by randomizing more than 30,000 patients to either etoricoxib or to the traditional NSAID diclofenate. Furthermore, the MEDAL investigators demonstrated similar cardiovascular outcome measures in both patient groups showing that the use of this has a similar cardiovascular safety profile as the traditional used NSAIDS. Using a safe analgesic with a low rate of adverse events in FMS patients, a population with enhanced somatoform ideation, is of great importance and may also insure the adherence to the other components of therapy.

Hypothesis - Adding etoricoxib, a COX-2 selective inhibitor, to the therapeutic regimens of patients with the FMS may ease their degree of pain; improve measures of over all quality of life, disability, sleep, anxiety and depression.

Objectives - Organic, mental and functional aspects of the FMS will be assessed in patients treated with etoricoxib (as an "add on") compared to placebo. The protocol-defined primary outcome measure will be pain severity as measured by the self-reported BPI (short form) average pain severity score (15).

Secondary endpoints will include tender point count, validated parameters that measure quality of life, quality of sleep, disability, pain, depression and anxiety and the fibromyalgia impact questionnaire (which measures physical function, pain assessment, fatigue and distress). The study will include eighty patients.

Study Type

Interventional

Enrollment (Anticipated)

80

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • • Women with established primary FMS who signed an informed consent form

    • Women 18-75 years old.
    • The score on the average pain severity item of the BPI is > 5 at randomization.
    • Patients on stable physical therapy or anelgestic pain treatment throughout the duration of the study.

Exclusion Criteria:

  • • Confirmed pregnancy

    • Breast feeding patients
    • Patients with active coronary artery disease with documented myocardial ischemia proven by coronary angiography, thallium scan or exercise stress test.
    • Patients with congestive heart failure
    • Patients with coexistent neoplastic conditions (not including basal cell carcinoma)
    • Patients with coexistent t rheumatic/inflammatory conditions
    • Patients with active gastrointestinal bleeding
    • Patients with renal failure
    • Patients with comorbid conditions causing significant disability
    • Patients with uncontrolled hypertension.
    • Patient with contraindications for the trial drug based on the drug's physician leaflet.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: B
Experimental: A
adding Etoricoxib to the basic therapeutic regimen

Treating Fibromyalgia with etoricoxib

etoricoxib - 90mg

Other Names:
  • Arcoxia

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Brief pain inventory
Time Frame: 6 weeks
6 weeks

Secondary Outcome Measures

Outcome Measure
Time Frame
Tender point count, SF-36, Mini International Neuropsychiatric Interview
Time Frame: 2 years
2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Howard Amital, MD MHA, Meir Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2008

Primary Completion (Actual)

October 1, 2010

Study Completion (Anticipated)

December 1, 2012

Study Registration Dates

First Submitted

September 18, 2008

First Submitted That Met QC Criteria

September 18, 2008

First Posted (Estimate)

September 19, 2008

Study Record Updates

Last Update Posted (Estimate)

August 10, 2012

Last Update Submitted That Met QC Criteria

August 9, 2012

Last Verified

August 1, 2012

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Fibromyalgia

Clinical Trials on etoricoxib

3
Subscribe