Presented at the 2012 AAPM Annual Meeting « Back

Diclofenac Sodium 1% Gel in Patients with Hand Osteoarthritis: Effectiveness in Patients with First Carpometacarpal Joint Involvement

John H. Peniston, DO, jhpdo@aol.com¹, Morris S. Gold, ScD², Matthew Wieman, MD³, Roy D. Altman, MD⁴, (1) Feasterville Family Health Care Center, Jamison, Pennsylvania, (2) Novartis Consumer Health, Parsippany, New Jersey, (3) Endo Pharmaceuticals Inc., Chadds Ford, Pennsylvania, (4) David Geffen School of Medicine, Los Angeles, California

Introduction/Statement of Problem: Diclofenac sodium 1% gel (DSG) is efficacious for treatment of osteoarthritis (OA) of the hand, but relative efficacy in the first carpometacarpal (CMC1) and intraphalangeal (IP) joints has not been compared. Materials and Methods: Patients (aged ≥40 y) with hand OA applied DSG or vehicle gel, 2 g per hand, four times daily for 8 weeks. Assessments at 6 weeks included pain intensity (100-mm Visual Analog Scale [VAS]) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) subscales for pain, stiffness, and function. Efficacy was compared in patients with OA in CMC1 only (n = 34), CMC1 plus ≥1 IP joint (CMC1+; n=241), and IP joints only (no CMC1; n = 110). Institutional review board approval and patient informed consent were obtained. Results: DSG was superior to vehicle in all patient subgroups for VAS pain (40%–49% vs. 34%–37% improvement) and AUSCAN pain (30%–43% vs. 28%–30%). Reductions in stiffness versus vehicle occurred for CMC1+ (42% vs. 27%) and no CMC1 (35% vs. 22%). Improvements in function versus vehicle occurred only for CMC1+ (41% vs. 28%) and no CMC1 (35% vs. 24%). For CMC1 only, improvements were similar for stiffness (24% vs. 21%) and function (25% vs. 25%). Conclusions: DSG reduced pain in all finger joints, but improved function and stiffness only in patients with OA of the IP joints. Because neither DSG nor vehicle have disease-modifying mechanisms, pain relief alone is likely responsible for the observed improvement of function and stiffness.

Funding: This study was funded by Endo Pharmaceuticals Inc., Chadds Ford, PA.