Recommended Dose of Etoricoxib for Rheumatoid Arthritis
The recommended dose of etoricoxib (Arcoxia) for the treatment of rheumatoid arthritis is 90 mg once daily. 1, 2
Efficacy Evidence
- Etoricoxib 90 mg once daily has demonstrated superior efficacy compared to placebo and similar efficacy to naproxen 500 mg twice daily in the treatment of RA 2
- In clinical trials, etoricoxib 90 mg was the only dose to reach statistically significant difference from placebo on the primary endpoint of ACR20 response (p < 0.001) 3
- While etoricoxib 60 mg approached statistical significance (p = 0.057) for ACR20 response, the 90 mg dose showed numerical superiority over all other doses studied 3
- Long-term studies (121 weeks) have confirmed that etoricoxib 90 mg provides sustained efficacy in RA treatment, comparable to naproxen 4
Dosing Considerations
- Although etoricoxib 60 mg has shown efficacy for pain improvement in RA (p = 0.018 vs placebo), the 90 mg dose consistently demonstrates superior overall efficacy 1, 3
- In a direct comparison study, both etoricoxib 60 mg and 90 mg were superior to placebo on Disease Activity Score (DAS28-CRP) and Patient Global Assessment of Pain (PGAP) 1
- Dose escalation from 60 mg to 90 mg did not significantly improve efficacy in patients with inadequate pain relief on the lower dose 1
Safety Profile
- Both etoricoxib 90 mg and 60 mg are generally well-tolerated in RA patients 1, 2
- Higher doses (60 mg and 90 mg) may be associated with increased risk of renovascular adverse events (edema and hypertension) compared to placebo, though discontinuations for these events are rare 3
- In comparative studies with diclofenac, etoricoxib 90 mg demonstrated a significantly lower risk for discontinuing treatment due to gastrointestinal adverse events 5
Place in Treatment Algorithm
- NSAIDs like etoricoxib are primarily used for symptom control in RA, while disease-modifying antirheumatic drugs (DMARDs) like methotrexate remain the anchor drugs for disease modification 6
- Etoricoxib should be considered as adjunctive therapy to disease-modifying treatments in RA, not as monotherapy for long-term management 6
- For optimal management, etoricoxib should be used at the minimum effective dose for the shortest time possible, with regular assessment of efficacy and adverse effects 6