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      A comparative study of the efficacy of NAXOZOL compared to celecoxib in patients with osteoarthritis

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          Abstract

          Objective

          Selective cyclooxygenase-2 inhibitors (celecoxib) can minimize the gastrointestinal complications related to non-steroidal anti-inflammatory drug (NSAID) use. NAXOZOL is a new combination formulation designed to provide sequential delivery of a non-enteric-coated, immediate-release esomeprazole strontium tetrahydrate 20 mg mantle followed by an enteric-coated naproxen 500 mg core. However, there have been no studies comparing NAXOZOL to celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis. This study was undertaken to compare the effects of NAXOZOL and celecoxib with respect to gastrointestinal tract protection and pain relief in patients with osteoarthritis.

          Methods

          The randomized enrolled patients were divided into two treatment groups: a NAXOZOL group and a celecoxib group. All participants received treatments (NAXOZOL, 500/20 mg (naproxen 500 mg, esomeprazole strontium tetrahydrate 20 mg) twice per day versus celecoxib, 200 mg daily) on a 1:1 allocation basis for 12 weeks. The primary outcome was the Leeds Dyspepsia Questionnaire (LDQ) score used for non-inferiority testing. Secondary outcome measures included the Gastrointestinal Symptom Rating Scale (GSRS) score, Visual Analogue Scale (VAS) score, European Quality of Life-5 dimensions (EQ-5D) scale and the EQ-5D Visual Analogue Scale (EQ VAS). Other outcome measures included the use of supplementary or rescue drugs, and the incidence of adverse events.

          Results

          The baseline-adjusted LDQ scores immediately after 12 weeks of treatment in NAXOZOL group were not inferior to those in celecoxib group. The overall change in the baseline-adjusted GSRS score, VAS score, EQ-5D, and EQ VAS was not different between the two groups. The usage of supplementary drugs and the drug-related incidence of adverse events were not different. However, the days to use rescue drug were longer in celecoxib group than in NAXOZOL group.

          Conclusion

          NAXOZOL was not inferior to celecoxib in protecting the gastrointestinal tract and providing pain relief in patients with osteoarthritis.

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          Most cited references24

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          A placebo-controlled trial of itopride in functional dyspepsia.

          The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with anti-acetylcholinesterase [corrected] effects, in patients with functional dyspepsia. Patients with functional dyspepsia were randomly assigned to receive either itopride (50, 100, or 200 mg three times daily) or placebo. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia (as assessed by the Leeds Dyspepsia Questionnaire), patients' global assessment of efficacy (the proportion of patients without symptoms or with marked improvement), and the severity of pain or fullness as rated on a five-grade scale. We randomly assigned 554 patients; 523 had outcome data and could be included in the analyses. After eight weeks, 41 percent of the patients receiving placebo were symptom-free or had marked improvement, as compared with 57 percent, 59 percent, and 64 percent receiving itopride at a dose of 50, 100, or 200 mg three times daily, respectively (P<0.05 for all comparisons between placebo and itopride). Although the symptom score improved significantly in all four groups, an overall analysis revealed that itopride was significantly superior to placebo, with the greatest symptom-score improvement in the 100- and 200-mg groups (-6.24 and -6.27, vs. -4.50 in the placebo group; P=0.05). Analysis of the combined end point of pain and fullness showed that itopride yielded a greater rate of response than placebo (73 percent vs. 63 percent, P=0.04). Itopride significantly improves symptoms in patients with functional dyspepsia. (ClinicalTrials.gov number, NCT00272103.). Copyright 2006 Massachusetts Medical Society.
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            Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAIDs and COX-2 inhibitors.

            Proton pump inhibitors reduce ulcer recurrence in non-steroidal anti-inflammatory drug (NSAID) users, but their impact in at-risk ulcer-free patients using the current spectrum of prescribed agents has not been clearly defined. We assessed esomeprazole for ulcer prevention in at-risk patients (> or = 60 yr and/or ulcer history) taking NSAIDs, including COX-2 inhibitors. Such studies are particularly relevant, given that concerns regarding adverse cardiovascular outcomes among COX-2 inhibitor users may prompt re-evaluation of their use. We conducted two similar double-blind, placebo-controlled, randomized, multicenter studies; VENUS (United States) and PLUTO (multinational). A total of 844 and 585 patients requiring daily NSAIDs, including COX-2 inhibitors were randomized to receive esomeprazole (20 or 40 mg) or placebo, daily for 6 months. In the VENUS study, the life table estimated proportion of patients who developed ulcers over 6 months (primary variable, intent-to-treat population) was 20.4% on placebo, 5.3% on esomeprazole 20 mg (p < 0.001), and 4.7% on esomeprazole 40 mg (p < 0.0001). In the PLUTO study, the values were 12.3% on placebo, 5.2% with esomeprazole 20 mg (p = 0.018), and 4.4% with esomeprazole 40 mg (p = 0.007). Significant reductions were observed for users of both non-selective NSAIDs and COX-2 inhibitors. Pooled ulcer rates for patients using COX-2 inhibitors (n = 400) were 16.5% on placebo, 0.9% on esomeprazole 20 mg (p < 0.001) and 4.1% on esomeprazole 40 mg (p= 0.002). Esomeprazole was well tolerated and associated with better symptom control than placebo. For at-risk patients, esomeprazole was effective in preventing ulcers in long-term users of NSAIDs, including COX-2 inhibitors.
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              Non-steroidal anti-inflammatory drug-induced cardiovascular adverse events: a meta-analysis.

              Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Validation
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Validation
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 January 2020
                2020
                : 15
                : 1
                : e0226184
                Affiliations
                [1 ] Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
                [2 ] Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
                [3 ] Department of Orthopedic Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea
                [4 ] Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
                [5 ] Department of Orthopaedic Surgery, Seoul National University, Seoul National University College of Medicine, Seoul, Republic of Korea
                [6 ] Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Republic of Korea
                [7 ] Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
                [8 ] Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
                Fondazione Toscana Gabriele Monasterio, ITALY
                Author notes

                Competing Interests: This study was supported by a research fund from Hanmi Pharmaceutical Co., Ltd (grant number HM-IITNAX-001). NAXOZOL(Naproxen, Esomeprazole strontium) was provided by Hanmi Pharmaceutical Co., Ltd. The funder provided support in the form of salaries for authors [MSP, CNK, WSL, HJK, SHL, JHK, SJS, SHM]. NAXOZOL is a combination drug of naproxen and esomeprazole strontium ("esomezol" proved in FDA) as a product marketed in only Korea currently. NAXOZOL was patented in 2013 as it contains esomeprazole strontium developed in Hanmi pharmaceutical company. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-5165-1159
                Article
                PONE-D-19-04676
                10.1371/journal.pone.0226184
                6984721
                31986170
                52217df8-8d06-4092-99c1-fc50b50113b0
                © 2020 Park et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 February 2019
                : 8 October 2019
                Page count
                Figures: 1, Tables: 7, Pages: 14
                Funding
                Funded by: Hanmi Pharmaceutical Co.,Ltd
                Award ID: HM-IIT-NAX-001
                Award Recipient :
                This study was supported by a research fund from Hanmi Pharmaceutical Co., Ltd (grant number HM-IITNAX-001). NAXOZOL® (Naproxen, Esomeprazole strontium) was provided by Hanmi Pharmaceutical Co., Ltd. The funder provided support in the form of salaries for authors [MSP, CNK, WSL, HJK, SHL, JHK, SJS, SHM], but did not have any additional role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. The funder was not involved in any part of the trial implementation or data analysis. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Medicine and Health Sciences
                Rheumatology
                Arthritis
                Osteoarthritis
                Medicine and health sciences
                Pharmacology
                Drugs
                Analgesics
                NSAIDs
                Medicine and health sciences
                Pain management
                Analgesics
                NSAIDs
                Physical Sciences
                Chemistry
                Chemical Elements
                Strontium
                Biology and Life Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Research and Analysis Methods
                Research Design
                Clinical Research Design
                Adverse Events
                Physical Sciences
                Chemistry
                Chemical Elements
                Magnesium
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Gastrointestinal Infections
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Gastrointestinal Cancers
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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