Weight is an important factor in osteoarthritis(OA)as obese subjects are at a higher risk of developing knee and hip OA. Obese patients have a higher risk of developing knee and hip pain, with increasing body weight resulting in more pain . As there is a rising obesity epidemic worldwide, it is expected the number of obese patients with knee OA will increase . Obesity is therefore an important preventable and treatable risk factor in patients with OA.
Some OA patients may experience asymptomatic periods alternating with OA flares while others may have continuous OA symptoms. Intermittent treatment with nonselective nonsteroidal anti-inflammatory drugs(NSAIDs)and cyclooxygenase-2(COX-2)selective inhibitors is often perceived as a safer option due to concerns regarding the gastrointestinal and cardiovascular adverse effects thought to be associated with these therapies. In patients with symptomatic OA who were successfully treated for an OA flare with open-label celecoxib, continuous celecoxib treatment was compared with intermittent celecoxib treatment in a double-blind, randomized, multicenter international trial to investigate the efficacy and safety of these regimens.
Continuous treatment with celecoxib 200 mg/d was significantly more efficacious than intermittent celecoxib treatment in preventing OA flares of the hip and knee, without an increase in overall adverse events(AEs), which included aggravated and new-onset hypertension . However, the effect of BMI on the efficacy of continuous versus intermittent NSAID treatment has not been previously
investigated. An exploratory analysis was performed to characterize the effect of BMI on the efficacy of continuous daily celecoxib treatment compared with intermittent celecoxib treatment, as measured by WOMAC total and subscale scores and by the number of flares.
To characterize the effect of body mass index(BMI)on the efficacy of continuous daily celecoxib treatment compared with intermittent celecoxib treatment, we prespecified an exploratory analysis of a 24-week, double-blind,parallel-group, randomized, multicenter international study. 858 patients with knee or hip osteoarthritis(OA)were randomized to receive celecoxib 200 mg daily either as continuous or intermittent treatment.
Efficacy was measured by Western Ontario and McMaster Universities.Arthritis Index(WOMAC)total and subscale scores and the number of flare events.Least squares mean increases(worsening)in WOMAC total scores were significantly less in the continuous treatment group than in the intermittent treatment group in patients with a BMI<30 kg/m2(1.33 vs 4.85; p=0.016)and in patients with a BMI ≥30 kg/m2(1.84 vs 5.12; p=0.019). There was a greater worsening in patients with a BMI≥30 kg/m2 than in those with a BMI<30 kg/m2 in both the continuous and intermittent groups. Fewer flares were reported in the continuous treatment group than in the intermittent group in patients with a BMI <30 kg/m2(0.55 vs 0.88; p<0.0001)and ≥30 kg/m2(0.54 vs 0.97; p<0.0001).
There were no differences in adverse events in the two BMI groups. These data suggest that daily celecoxib treatment was significantly more efficacious than intermittent use, and more so in patients with a BMI<30 kg/m2 compared with obese patients(BMI≥30 kg/m2)as assessed by WOMAC total scores and the number of flares per month. These data support the importance of including weight loss as part of the treatment regimen for obese and perhaps overweight patients with OA and suggest weight loss could help reduce the burden of illness experienced by these OA patients.
