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Table 2 Incidence of musculoskeletal symptoms in patients treated with aromatase inhibitors versus tamoxifen or placebo in randomized phase III trials

From: Aromatase inhibitor-associated bone and musculoskeletal effects: new evidence defining etiology and strategies for management

Study Treatment arms (years of treatment) Symptom Aromatase inhibitor (%) Tamoxifen/placebo (%) P-value
ATAC [11, 12] Anastrozole (5) versus Tamoxifen (5) Arthralgia 35.6 29.4 < 0.0001
   Carpal tunnel syndrome 3 1 < 0.0001
ABCSG8/ARNO95 [16] Tamoxifen (2-3) → Anastrozole (3) Versus Tamoxifen (5) Bone pain 19 16 0.0546
ABCSG6a [17] Tamoxifen (5) → Anastrozole (3) Versus Tamoxifen (5) → Placebo (3) Bone pain including joint pain 24.5 18.3 0.009
ITA [20] Tamoxifen (2-3) → Anastrozole (2-3) Versus Tamoxifen (5) MSK disorders and bone fractures 9.9 6.7 0.2
BIG 1-98 [13] Letrozole (5) versus Tamoxifen (5) Arthralgia 20 13.5 < 0.001
   Myalgia 7.1 6.1 0.19
IES [14] Tamoxifen (2-3) → Exemestane (2-3) versus Tamoxifen (5) Arthritis 14.1 12.0 0.03
   Arthralgia 18.6 11.8 < 0.0001
   Carpal tunnel syndrome 2.8 0.3 < 0.0001
   MSK pain 21 16.1 < 0.0001
   Cramps 2.3 4.2 0.0002
   Joint stiffness 1.9 1 0.009
NSABP B33 [18] Tamoxifen (5) → Exemestane (5) versus Tamoxifen (5) → Placebo (5) Arthralgia 1 0.5 NA
MA17 [15] Tamoxifen (5) → Letrozole (5) versus Tamoxifen (5) → Placebo (5) Arthritis 6 5 0.07
   Arthralgia 25 21 < 0.001
   Myalgia 15 12 0.004
   Bone pain 5 6 0.67
  1. ABCSG, Austrian Breast and Colorectal Cancer Study Group; ARNO, Arimidex-Nolvadex; ATAC, Arimidex, Tamoxifen, Alone or in Combination; BIG, Breast International Group; DFS, disease-free survival; IES, International Exemestane Study; ITA, Italian Trial of Anastrozole; MSK, musculoskeletal; NA, not available; NSABP, National Surgical Adjuvant Breast and Bowel Project.