COX-2 inhibitor may relieve prostatitis symptoms
Anonymous
symptoms : Half of men with
noninflammatory prostatitis report 'good'
improvement at higher dose.
Scott Tennant
04/01/2001
Urology Times 7
Arlington, VA--Men with category III
chronic prostatitis/chronic pelvic pain
syndrome (CPPS) appeared to derive
symptomatic improvement from treatment
with a cyclooxygenase-2 (COX-2) inhibitor in
a multicenter, randomized, placebo-
controlled study.
J. Curtis Nickel, MD, reported results of the
161-patient phase II trial of rofecoxib
(Vioxx) at the Third International Prostatitis
Collaborative Network workshop here.
Improvement was based on pain, voiding
symptoms, and quality of life associated
with CP/CPPS. "This is the first large-scale,
randomized, placebo-controlled trial of
category III prostatitis ever funded by the
pharmaceutical industry," said Dr. Nickel,
presenting the results on behalf of
investigators from 25 different institutions
throughout the United States and Canada,
and Merck Research Laboratories, which
funded the study. "It is hoped it will be the
first of many, because that's the only way
we're going to make progress against this
condition."
After 1 week on placebo, patients were
randomized to 6 weeks of treatment with
either placebo, rofecoxib, 25 mg daily, or
rofecoxib, 50 mg daily. All patients were
above the age of 18 years, and baseline
characteristics such as age, height, weight,
pain level, and race were similar across the
three cohorts. (Rofecoxib is FDA-approved
for the treatment of osteoarthritis, acute
pain, and primary dysmenorrhea.)
All patients met the National Institutes of
Health's definition of category III CP/CPPS.
About two-thirds of them were classified as
having category IIIb prostatitis
(noninflammatory CPPS), while the other
one-third of men had category IIIa disease
(inflammatory CPPS).
More improvement at higher dose
Men in all three arms of the study showed
improvement, but patients receiving the 50-
mg dose of rofecoxib fared best on NIH
chronic prostatitis symptom index and
global assessment questionnaires. About
half of category IIIb patients rated their
improvement as "good" or "excellent."
Investigators found that the global
assessment questions were more sensitive
indicators of the response to therapy,
prompting one audience member to
question whether the NIH index is a valid
tool.
"The NIH chronic prostatitis symptom index
was developed and validated as a baseline
measure," Dr. Nickel said. "It needs this and
other studies to determine its actual
sensitivities. We may need to tweak it a
bit."
Preliminary data analyses also showed that
rofecoxib was well-tolerated by CPPS
patients. Still, Dr. Nickel emphasized the
need for further studies to determine the
drug's place in treating these men.
"I would advise caution because more
investigation is required before this
medication can be recommended across the
board for nonbacterial chronic prostatitis,"
he said.
Beeskay Bagah
Analgesic and anti-inflammatory activity of the proanthocyanidin
shellegueain A
from Polypodium feei METT.
Subarnas A, Wagner H.
Department of Pharmacy, Faculty of Mathemadics and Natural Sciences,
Padjadjaran
University, Sumedang, Indonesia. an...@bdg.centrin.net.id
Analgesic and antiinflammatory activity of proanthocyanidin isolated from
Polypodium feei roots has been tested using acetic acid-induced writhing and
carrageenan-induced paw edema methods, respectively. The compound at doses
of 50
and 100 mg/kg significantly decreased writhing responses of mice induced by
0.7
% acetic acid along the 60 min test in a dose-dependent manner. The compound
at
a dose of 100 mg/kg gave the percent protection of 76.23 higher than that of
acetylsalicylic acid (59.84 %) at a dose of 50 mg/kg. In the
antiinflammatory
test, this compound caused significant inhibition of the rats' plantar edema
induced by 1 % of carrageenan, but this activity was observed only at a
higher
dose (200 mg/kg). These findings suggest that proanthocyanidin of P. feei
roots
might have analgesic and antiinflammatory activity, and its mechanism of
action
might be due to the inhibition of prostaglandin biosynthesis, because the
proanthocyanidin fraction had an inhibitory effect on cyclooxygenase, but
not on
5-lypoxygenase enzymes.
PMID: 11081991 [PubMed - indexed for MEDLINE]
2: Altern Med Rev 2000 Apr;5(2):144-51
Oligomeric proanthocyanidin complexes: history, structure, and
phytopharmaceutical applications.
Fine AM.
International Clinical Research Center, Scottsdale, AZ 85260, USA.
Considerable recent research has explored therapeutic applications of
oligomeric
proanthocyanidin complexes (OPCs), naturally occurring plant metabolites
widely
available in fruits, vegetables, nuts, seeds, flowers, and bark. OPCs are
primarily known for their antioxidant activity. However, these compounds
have
also been reported to demonstrate antibacterial, antiviral,
anticarcinogenic,
anti-inflammatory, anti-allergic, and vasodilatory actions. In addition,
they
have been found to inhibit lipid peroxidation, platelet aggregation,
capillary
permeability and fragility, and to affect enzyme systems including
phospholipase
A2, cyclooxygenase, and lipoxygenase. Based on these reported findings, OPCs
may
be a useful component in the treatment of a number of conditions.
Publication Types:
Review
Review, tutorial
PMID: 10767669 [PubMed - indexed for MEDLINE]
John Garst
Anonymous <nob...@remailer.privacy.at> wrote:
> COX-2 inhibitor may relieve prostatitis
> symptoms : Half of men with
> noninflammatory prostatitis report 'good'
> improvement at higher dose.
This is curious. My recollection is that Nickel's earlier report
indicated no significant improvement with Vioxx (over placebo). Has
something changed? Are the higher doses new?
Daniel Shoskes MD
<ga...@chem.uga.edu> wrote:
If you read the article, you see that the improvement was seen "in all
groups". That includes the placebo group. You are correct, the
improvement with vioxx was NOT significantly better than placebo.
Daniel Shoskes MD
Cleveland Clinic Florida
http://www.dshoskes.com
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