Rationale for using nabumetone and clinical experience

Nabumetone's position as one of the most commonly used nonsteroidal antiinf lammatory drugs (NSAIDs) in the world today is based upon over a decade of clinical experience. The popularity of this drug lies in both its unique ph armacokinetic profile and special safety features in pharmacodynamic terms. This nonacidic prodrug with an active 6-methoxy-2-naphthylacetic acid (6-M NA) metabolite has COX-2 preferential features and is also devoid of entero hepatic recirculation. It is felt that these characteristics have provided the basis for its unique long term tolerability, documented in various at-r isk osteoarthritis and rheumatoid arthritis populations. The excellent tole rability of nabumetone and its 24-hour half-life, which provides the advant ages of a once-daily dosage regimen, make it uniquely suitable for long ter m anti-inflammatory therapy in arthritis. The tolerability profile of nabumetone has also demonstrated clear cost-eff ectiveness advantages, as confirmed by comparative and epidemiological stud ies. Selective COX-2 NSAIDs are likely to prove more expensive because of t he increasing costs and demands of clinical research prior to FDA approval. These higher costs may limit and influence patient access, depending on th e healthcare delivery system, and many years of experience will be required to document the putative tolerability advantages of these newer COX-2 inhi bitor agents. In the meantime, it is comforting that nabumetone has establi shed such an advantageous tolerability profile together with acknowledged e fficacy.