Further experience with indomethacin in the treatment of rheumatic disorders.

Abstract

Indomethacin (Indocid) is an indole-3-acetic acid derivative, which was found to have powerful anti-inflammatory and anal gesic properties, and which has been under clinical investiga tion since October 1962. Several controlled trials demonstrated that it had some value in the treatment of rheumatic disorders, being significantly more effective than placebos in the treatment of both rheumatoid arthritis (Wanka, Jones, Wood, and Dixon, 1964) and osteoarthrosis of the hip (Wanka and Dixon, 1964). When indomethacin was compared with phenylbutazone in a controlled trial in rheumatoid arthritis (Percy, Stephenson, and Thompson, 1964) no significant difference was noted either in terms of relief of pain or by improvement in grip-strength, but side-effects were commoner with indomethacin. All these early studies were undertaken with indomethacin in tablet form, and it was found that this preparation had disadvantages owing to variable dissolution rates of the tablets and erratic absorption from the gastro-intestinal tract. The use of capsules, available since September 1963, overcame these difficulties, and sub sequent clinical experience indicated that a commensurate clinical effect could be obtained with a lower dosage of indo methacin in capsule form than when it was administered as tablets (Thompson, 1964). Experience with other drugs used in the treatment of chronic rheumatic disorders, notably with the predni-steroids, has shown that potency of a drug does not establish its place as the therapeutic agent of choice. Controlled clinical trials of short duration serve to estimate the immediate value of a drug and any early side-effects, but it is only by means of long-continued clinical experience that answers may be provided to such ques tions as the frequency, severity, and nature of adverse side effects, optimum dosage levels, and the indications for or against the use of the drug. As indomethacin became available for use in general practice in March 1965 we are recording our experience of a group of 137 patients treated with 25-mg. capsules during the 82 weeks from September 1963 to April 1965.