Piroxicam in the Treatment of Osteoarthrosis: A Multicentre Study in General Practice Involving 1218 Patients

Abstract

A non-comparative multicentre trial was conducted by 156 general practitioners with 1218 patients in eight European countries to assess the efficacy and toleration of once daily doses of piroxicam in the treatment of osteoarthrosis (degenerative joint disease). Drug was taken for an average of 2.5 months with more than 75% on piroxicam for 7 weeks or more. The maintenance dose in 81% of all patients was the same as the recommended starting dose of 20 mg, taken once daily after breakfast. Although more than 40% of patients received concurrent analgesic/anti-inflammatory drug(s) at the beginning of the trial, only 10% to 15% took such therapy by the end of their treatment period. Most patients had moderate or severe involvement in one or more of knee, spine, hip, digit, or shoulder joints. From 75% to 80% of patients reported marked or moderate improvement in ability to move and use joints and their general overall feeling (‘quality of life’ measurement). Patients' self-assessment of joint pain and stiffness showed from 25% to 30% reduction after 2 weeks on drug and up to 60% reduction by the end of the treatment period. Onset of morning pain at baseline occurred within 1 to 2 hours after waking, but by final evaluation, the average time had risen to 6 hours in those patients still experiencing pain. Side-effects definitely attributed to piroxicam were reported by 13% of all patients; there were sixty discontinuations (5%) due to drug. The majority of side-effects were upper gastro-intestinal in origin, primarily epigastric distress, nausea, and indigestion. Most side-effects were mild or moderate and were experienced without incident within the first three weeks on drug. In their global evaluation, investigators judged the efficacy of piroxicam as marked or moderate in 82% of patients while toleration was considered excellent or good in 92% of cases. In comparison to a patient's prior therapy, investigators considered piroxicam better in its overall effect in 72% of the cases. In summary, the data show that once-daily doses of piroxicam, mostly 20 mg, can provide very favourable efficacy and toleration in the treatment of osteoarthritis in general practice.