Etoricoxib Medication

[DebbieP100]

Was just wondering if anyone else is being treated with Etoricoxib 90 mg in the evening for PMR? My rheumatologist got me off steroids after 3 months and put me on this. And it works well. But I can’t find much about it side effects/long term use v steroids

Any help appreciated. Thanks

[SheffieldJane]

Hi Debbie, I googled Extoricoxib as I had not heard of it, especially in relation to PMR. Quite a lot comes up about uses and side effects. It appears to be a drug that is used for osteoarthritis and other arthritic conditions. The side effects seem to indicate that it is quite harsh on the digestive system, there can also be an impact on the heart function. Obviously it is good that you feel well on the drug, but it is surprising, in our experience nothing much helps PMR and GCA except Prednisalone.

I am not sure what the advantages are in switching to another fairly powerful drug that is not specifically indicated for our condition. I would ask my doctor to explain. If you feel well, this is a huge factor.

[DebbieP100 in reply to SheffieldJane]

Thanks for that interesting am going next week to the Dr so will ask

[PMRpro Ambassador]

Etoricoxib is also called Arcoxia, a selective COX-2 inhibitor. It is not approved in the USA because the FDA wants more safety information. Personally I wouldn't take it as it is associated with an increased risk of cardiovascular events compared to placebo - and given the median duration of PMR is just under 6 years I wouldn't wish to be taking it for that long. Pred may have side effects - but so do all medications and sometimes they are worse.

"Etoricoxib is a new COX-2 selective inhibitor. Current therapeutic indications are: treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain and gout. Like any other COX-2 selective inhibitor, Etoricoxib selectively inhibits isoform 2 of cyclo-oxigenase enzyme (COX-2). This reduces the generation of prostaglandins (PGs) from arachidonic acid."

I will definitely say here - I would doubt you really have PMR if it helps. In fact, I would be asking for investigation for ankylosing spondylitis (AS) - which can present looking just like PMR and will respond fairly well to pred at PMR doses but this drug is good at managing. There are alternative to it though for AS. It might not be - but if etoricoxib works it has to cast doubt on the diagnosis of PMR.

Have you tried NSAIDs? This doesn't seem to think highly of etoricoxib in comparison:

ncbi.nlm.nih.gov/pubmed/180...

Some of the COX-2 inhibitors were pulled from the market because of the cardiovascular effects:

"Unfortunately, there is a possible increase in complications because of heart attack, thrombosis, and stroke by a relative increase in thromboxane in these medications, which caused rofecoxib to be pulled from the marked in 2004, and valdecoxib in 2005."

[DebbieP100 in reply to PMRpro]

That’s interesting. I started off with Pred and that worked well. I don’t seem to fit into any of the other group AS RA etc I had a knee scan which seemed to indicate arthropothy. I am RAneg and all

My blood levels came down swiftly. They were only slightly raised initially. The Rheumatologist admitted she could not pin point a clear diagnosis but something auto immune. I am currently reducing the Etoricoxib and now taking 4 nights a week. Do you think I should go to another Rheumatologist for a clear diagnosis? The most of my symptoms are related to PMR

Not classic joint issues of arthritis. Never had any back pain ever either

It’s a mystery

[PMRpro Ambassador in reply to DebbieP100]

I had a friend on the forums who was originally diagnosed with PMR and it wasn't until she struggled to get off pred that there were any problem. Then she had tongue symptoms which could have been GCA but her doctor wouldn't have it - until he sent her to Dasgupta who agreed it probably had been but it was too late to treat it with steroids - which were the only thing that provided relief.

Anyway, eventually she managed to get to see Prof Mackie in Leeds who also thought it was PMR until my friend happened to mention her "PMR" pain was worst at night. That was all. An MRI showed the spinal changes of AS and her treatment was changed.

PMR isn't the disease - it is the name given to the outward expression of some underlying disease process and there are quite a few. My friend didn't have joint pain either. You can have both - though it isn't common:

ncbi.nlm.nih.gov/pubmed/927...

and a top expert in the field says MRI may be useful in such cases

ard.bmj.com/content/71/Supp...

I think in the early stages there may not be back pain - it is worth considering.

[piglette in reply to PMRpro]

Another Merck special!

[PMRpro Ambassador in reply to piglette]

That's right - I sort of half noted that ...

[Bonnie-ma]

Hi Debbie,

On the subject of Arcoxia or Etoricoxib, I have been taking this very effective anti inflammatory for several years. I take 60mgs O.D. as not licensed in the UK for any higher dosage for OA. I take it for osteo arthritis in my knees. It has no effect on my PMR. I cannot take any other anti inflammatory without nasty side effects and this drug is very very good at controlling my pain. It is expensive so GP’s don’t like to prescribe it. My orthopaedic surgeon recommended it. I am aware of the side effects but severe pain also has its negative effect on my body so it’s a bit of a toss up!

[Bamber99]

I took arcoxia for 8 years for arthritis pre PMR. Stopped when Pred was prescribed. I had no side effects.