Randomized, Placebo Controlled Study of the Effects of Etoricoxib on Markers of Inflammation, Pain and Muscle Force After Eccentric Exercise

Objectives: Investigation of etoricoxib treatment on markers of inflammation, pain and muscle force after eccentric exercise. Methods: This randomized, placebocontrolled, double blinded, cross over study investigated 50 healthy subjects presenting pain during muscle contraction of ≥5 (range: 0-10) after two runs of eccentric exercise at 45 % of peak torque until volitional fatigue. Subjects were stratified into a young and elderly population (strata1: 18-40 years; strata 2: 50-70 years) and randomized to treatment with etoricoxib (90 mg q.d.) or placebo (1:1) for 7 days. Subjects receiving etoricoxib in period I received placebo in period II. The target leg for exercise in periode I was also determined by randomization. In periode II, the contralateral leg was trained and investigated. Investigations included pain at rest, pain during evaluation of peak torque (11 point numerical analog scale), heat pain threshold at trigger points, peak torque and markers of inflammation (high sensitive C-reactive Protein, sedimentation rate, leucocyte number). Results: Etoricoxib failed to show significant treatment effects on pain during contraction and rest after eccentric exercise as compared to placebo, except a non-significant trend for reduction of pain at rest for the first 24 h. There was evidence of delayed recovery of peak torque and reduced pain with etoricoxib treatment. Etoricoxib induced significant anti-inflammatory effects as shown by reduction in hsCrP as compared to placebo (p=0.0203). Discussion: Despite an anti-inflammatory effect, etoricoxib failed to provide a relevant treatment effect on muscle soreness after eccentric exercise and might even delay recovery. Considering similar reports in the literature, the use of both non-selective and Cox-2 selective NSAIDs cannot be supported in subjects with muscle pain after exercise.