Rofecoxib versus codeine/acetaminophen in postoperative dental pain: A double-blind, randomized, placebo- and active comparator-controlled clinical trial
Dj. Chang et al., Rofecoxib versus codeine/acetaminophen in postoperative dental pain: A double-blind, randomized, placebo- and active comparator-controlled clinical trial, CLIN THER, 23(9), 2001, pp. 1446-1455
Background: In recent studies of acute pain and primary dysmenorrhea, rofec
oxib, a nonsteroidal anti-inflammatory drug that selectively targets the cy
clooxyoenase-2 enzyme, was found to be similar in efficacy to ibuprofen and
naproxen sodium.
Objective: The purpose of this study was to determine the analgesic efficac
y of a single oral dose of rofecoxib 50 mg compared with the combination of
codeine 60 mg/acetaminophen 600 mg in a model of postsurgical dental pain.
Methods: In this double-blind, placebo- and active comparator-controlled, p
arallel-group study, patients experiencing moderate or severe pain after th
e surgical extraction of greater than or equal to2 third molars, at least 1
of which was a mandibular impaction, were randomized to receive placebo, r
ofecoxib 50 mg, or codeine 60 mg/acetaminophen 600 mg. Patient evaluations
of pain intensity, pain relief, and global assessments were recorded throug
hout the 24-hour period after dosing. The 2-stopwatch method was used to de
termine time to confirmed perceptible pain relief. The primary end point as
sessing overall analgesic effect was total pain relief over 6 hours (TOPAR6
). Secondary end points were patient global assessment of response to thera
py (PGART) at 6 hours, onset of analgesia, peak analgesic effect, and durat
ion of analgesia.
Results: A total of 393 patients were enrolled; 182 received rofecoxib, 180
received codeine/acetaminophen, and 31 received placebo. The overall analg
esic effect of rofecoxib 50 mg was greater than that of codeine 60 mg/aceta
minophen 600 mg for TOPAR6 (12.4 vs 7.0; P<0.001) and PGART at 6 hours (P<0
.001). The onset of analgesic effect was similar for rofecoxib and codeine/
acetaminophen. Peak analgesic effect as measured by peak pain relief scores
during the first 6 hours was significantly greater in the rofecoxib group
compared with the codeine/acetaminophen, group (P<0.001), as was the durati
on of analgesic effect measured by the time to rescue analgesia (9.6 hours
vs 2.3 hours, P<0.001). Adverse events were reported in 33.0%, 46.1%, and 3
2.3% of patients treated with rofecoxib, codeine/acetaminophen, and placebo
, respectively. The most common adverse events were nausea (6.0%, 25.0%, an
d 9.7%, respectively) and vomiting (3.8%, 18.3%, and 6.5%, respectively). S
ignificantly more patients in the codeine/acetaminophen group than in the r
ofecoxib group experienced adverse events overall (P<0.050) and nausea in p
articular (P<0.001).
Conclusion: In this study of moderate to severe postoperative dental pain,
the analgesic efficacy of rofecoxib, 50 mg was greater than that of codeine
/acetaminophen, with a lower incidence of adverse events and nausea.