Evaluation of the patient acceptable symptom state in a pooled analysis of two multicentre, randomised, double-blind, placebo-controlled studies evaluating lumiracoxib and celecoxib in patients with osteoarthritis

Abstract

Patient Acceptable Symptom State (PASS) is an absolute threshold proposed for symptomatic variables in osteoarthritis (OA) to determine the point beyond which patients consider themselves well and, as such, are satisfied with treatment. Two large previously reported studies of knee OA have shown that both lumiracoxib and celecoxib were superior to placebo in terms of conventional outcome measures. To assess the clinical relevance of these results from the patient's perspective, the same data pooled from these two studies were analysed with respect to the PASS. In total, 3,235 patients were included in two multicentre, randomised, double-blind studies of identical design. Patients were randomly assigned to receive lumiracoxib 100 mg once daily (n = 811), lumiracoxib 100 mg once daily with an initial dose of lumiracoxib 200 mg once daily for the first 2 weeks (100 mg once daily with initial dose [n = 805]), celecoxib 200 mg once daily (n = 813), or placebo (n = 806) for 13 weeks. Treatments were compared with respect to the PASS criteria (for OA pain, patient's global assessment of disease activity, and the Western Ontario and McMaster Universities Osteoarthritis Index Likert version 3.1 [WOMAC LK 3.1] Function [difficulty in performing daily activities] subscale score). At week 13, 43.3%, 45.3%, and 42.2% of patients in the lumiracoxib 100 mg once daily, lumiracoxib 100 mg once daily with initial dose, and the celecoxib 200 mg once daily groups, respectively, considered their current states as satisfactory versus 35.5% in the placebo group. Similar results were observed for patient's global assessment of disease activity and WOMAC LK 3.1 Function subscale score. This post hoc analysis suggests that the statistical significance of the results observed with lumiracoxib or celecoxib compared with placebo using conventional outcome variables is complemented by clinical relevance to the patient.

Trial registration numbers: NCT00366938 and NCT00367315.

Figures

Figure 1

Patient flow diagram.

Figure 2

Osteoarthritis pain intensity in the target knee. (a) Percentage of patients considering their state as satisfactory according to Patient Acceptable Symptom State (PASS) at weeks 2, 4, 8, and 13. **P < 0.01; ***P < 0.001 versus placebo logistic regression model adjusted for multiple comparisons. (b) Kaplan-Meier estimate of the probability of first sustained satisfaction with treatment maintained until week 13 according to PASS. P < 0.001 versus placebo for all active treatments using both log-rank and Wilcoxon tests except for lumiracoxib with initial dose versus placebo using Wilcoxon (P < 0.0001).

Figure 3

Patient's global assessment of disease activity. (a) Percentage of patients considering their state as satisfactory according to Patient Acceptable Symptom State (PASS) at weeks 2, 4, 8, and 13. **P < 0.01; ***P < 0.001 versus placebo logistic regression model adjusted for multiple comparisons. (b) Kaplan-Meier estimate of the probability of first sustained satisfaction with treatment maintained until week 13 according to PASS. P < 0.001 versus placebo for all active treatments using both log-rank and Wilcoxon tests.

Figure 4

Western Ontario and McMaster Universities Osteoarthritis Index Likert version 3.1. Function subscale score. (a) Percentage of patients considering their state as satisfactory according to Patient Acceptable Symptom State (PASS) at weeks 2, 8, and 13. ***P < 0.001 versus placebo logistic regression model unadjusted for multiple comparisons.(b) Kaplan-Meier estimate of the probability of first sustained satisfaction with treatment maintained until week 13 according to PASS. P < 0.001 versus placebo for all active treatments using both log-rank and Wilcoxon tests.

Figure 5

Response to treatment according to criteria of Outcome Measures in Clinical Trials-Osteoarthritis Research Society International. ***P < 0.001 versus placebo logistic regression model unadjusted for multiple comparisons.