Lumiracoxib for dysmenorrhoea
Clinical bottom line
Lumiracoxib 400 mg once daily is effective for the control of pain in dysmenorrhoea. The NNT for a global outcome of good or excellent is 3-4, and 50% of women will have this outcome.
Background
Bandolier 120 looked at a systematic review [1] of NSAIDs for dysmenorrhoea, and Bandolier 121 found four randomised trials of coxibs for dysmenorrhoea. Pain with dysmenorrhoea usually lasts for about three days, though with considerable individual variation. Trials of analgesics can have various forms. The simplest might be to give the same analgesic for the whole of the painful cycle, and ask a global question concerning efficacy at the end. Women might then be crossed over to a different treatment at the next cycle. This was the design used for NSAID comparisons with placebo, with the outcome of at least moderate pain relief over the cycle.
A variation would be to use the same basic structure, but make more detailed evaluations of pain or pain relief over a limited time during the first day. This was the approach used in the coxib trials in Bandolier 121, and in a new report of two trials with lumiracoxib.
Reference
M Bitner et al. Efficacy and tolerability of lumiracoxib in the treatment of primary dysmenorrhoea. International Journal of Clinical practice 2004 58: 340-345.
Review
The report was of two cross-over studies comparing lumiracoxib 400 mg once a day with placebo, rofecoxib 50 mg once a day, and naproxen 500 mg twice daily. Pain intensity and relief were measured over 12 hours, with a global evaluation of outcome. There were 330 women in the comparison of lumaricoxib and placebo.
Results
A global outcome of good or excellent was achieved by 53% of women on luimaricoxib 400 mg and 26% of women on placebo. The NNT for a good or excellent result was 3.8 (2.7 to 6.2).
Comment
We have here a reasonable amount of information (in terms of dysmenorrhoea trials of analgesics), with good efficacy in single doses.