Nabumetone: therapeutic use and safety profile in the management of osteoarthritis and rheumatoid arthritis.

Abstract

Nabumetone is a nonsteroidal anti-inflammatory prodrug, which exerts its pharmacological effects via the metabolite 6-methoxy-2-naphthylacetic acid (6-MNA). Nabumetone itself is non-acidic and, following absorption, it undergoes extensive first-pass metabolism to form the main circulating active metabolite (6-MNA) which is a much more potent inhibitor of preferentially cyclo-oxygenase (COX)-2. The three major metabolic pathways of nabumetone are O-demethylation, reduction of the ketone to an alcohol, and an oxidative cleavage of the side-chain occurs to yield acetic acid derivatives. Essentially no unchanged nabumetone and < 1% of the major 6-MNA metabolite are excreted unchanged in the urine from which 80% of the dose can be recovered and another 10% in faeces. Nabumetone is clinically used mainly for the management of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) to reduce pain and inflammation. The clinical efficacy of nabumetone has also been evaluated in patients with ankylosing spondylitis, soft tissue injuries and juvenile RA. The optimum oral dosage of nabumetone for OA patients is 1 g once daily, which is well tolerated. The therapeutic response is superior to placebo and similar to nonselective COX inhibitors. In RA patients, nabumetone 1 g at bedtime is optimal, but an additional 0.5-1 g can be administered in the morning for patients with persistent symptoms. In RA, nabumetone has shown a comparable clinical efficacy to aspirin (acetylsalicylic acid), diclofenac, piroxicam, ibuprofen and naproxen. Clinical trials and a decade of worldwide safety data and long-term postmarketing surveillance studies show that nabumetone is generally well tolerated. The most frequent adverse effects are those commonly seen with COX inhibitors, which include diarrhoea, dyspepsia, headache, abdominal pain and nausea. In common with other COX inhibitors, nabumetone may increase the risk of GI perforations, ulcerations and bleedings (PUBs). However, several studies show a low incidence of PUBs, and on a par with the numbers reported from studies with COX-2 selective inhibitors and considerably lower than for nonselective COX inhibitors. This has been attributed mainly to the non-acidic chemical properties of nabumetone but also to its COX-1/COX-2 inhibitor profile. Through its metabolite 6-MNA, nabumetone has a dose-related effect on platelet aggregation, but no effect on bleeding time in clinical studies. Furthermore, several short-term studies have shown little to no effect on renal function. Compared with COX-2 selective inhibitors, nabumetone exhibits similar anti-inflammatory and analgesic properties in patients with arthritis and there is no evidence of excess GI or other forms of complications to date.

• Authors: Thomas Hedner, Ola Samulesson, Peter Währborg, Hans Wadenvik, Kjell-Arne Ung, Anders Ekbom
• Journal: Drugs (Drugs) Vol. 64 Issue 20 Pg. 2315-43; discussion 2344-5 ( 2004) ISSN: 0012-6667 [Print] New Zealand
• PMID: 15456329 (Publication Type: Journal Article, Review)
• Copyright: Copyright 2004 Adis Data Information BV

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Butanones
• Cyclooxygenase Inhibitors
• Nabumetone

Topics

• Adolescent
• Adult
• Aged
• Animals
• Anti-Inflammatory Agents, Non-Steroidal (metabolism, pharmacokinetics, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Butanones (metabolism, pharmacokinetics, therapeutic use)
• Child
• Child, Preschool
• Clinical Trials as Topic
• Cyclooxygenase Inhibitors (adverse effects, therapeutic use)
• Drug Interactions
• Food-Drug Interactions
• Humans
• Middle Aged
• Nabumetone
• Osteoarthritis (drug therapy)
• Stomach Diseases (chemically induced)