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Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys.

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are at the cornerstone of treatment for osteoarthritis (OA). In recent years, the widespread use of oral NSAIDs has been called into question due to the appearance of significant upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events (AEs). However, NSAIDs are non-homogeneous, and there are noticeable differences between them in AE risk for GI and CV events. Nevertheless, if properly prescribed oral NSAIDs can provide an effective and safe treatment for OA in real-life situations. The identification of patients with significant CV and/or GI risk is critical, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm provides guidance on appropriate treatments for OA patients with elevated risk. Among non-selective NSAIDs, ibuprofen and naproxen seem preferable to diclofenac, the latter being associated with higher CV risk. Recommendation has been made by some that naproxen may be the preferred agent in patients at high CV risk because of its lower risk of CV events. Low dose celecoxib (200mg/day) is also associated with a lower risk of CV events compared with other coxibs. In addition, drugs with a demonstrated low GI risk profile may be of benefit, such as coxibs and nabumetone. Among patients who fail to respond adequately to sequential ESCEO algorithm Step 1 and Step 2 treatments, the short-term use of weak opioids, such as tramadol, for severely symptomatic OA patients is recommended. Although studies exploring the efficacy of tramadol in OA are limited, there is good evidence that tramadol works if prescribed properly. The sustained-release (SR) formulation of tramadol is preferred as it avoids the peak plasma concentrations reached with immediate-release tramadol, and is believed to reduce the incidence of AEs. Furthermore, slow upwards titration of tramadol SR is recommended to improve tolerability and minimize treatment discontinuations.

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  • Authors+Show Affiliations

    ,

    Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Tour Viger, 900 St-Denis Street, Montreal, QC H2X 0A9, Canada. Electronic address: dr@jppelletier.ca.

    ,

    Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Tour Viger, 900 St-Denis Street, Montreal, QC H2X 0A9, Canada.

    ,

    Rehabilitation Unit, Rheumatology Department, Hôpital Cochin, AP-HP, INSERM UMR-S 1124, Université Paris Descartes, Paris, France.

    MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.

    Source

    Seminars in arthritis and rheumatism 45:4 Suppl 2016 Feb pg S22-7

    MeSH

    Analgesics
    Anti-Inflammatory Agents, Non-Steroidal
    Cardiovascular Diseases
    Evidence-Based Medicine
    Gastrointestinal Diseases
    Humans
    Osteoarthritis
    Randomized Controlled Trials as Topic
    Risk Factors

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng

    PubMed ID

    26806184

    Citation

    Pelletier, Jean-Pierre, et al. "Efficacy and Safety of Oral NSAIDs and Analgesics in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys." Seminars in Arthritis and Rheumatism, vol. 45, no. 4 Suppl, 2016, pp. S22-7.
    Pelletier JP, Martel-Pelletier J, Rannou F, et al. Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S22-7.
    Pelletier, J. P., Martel-Pelletier, J., Rannou, F., & Cooper, C. (2016). Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Seminars in Arthritis and Rheumatism, 45(4 Suppl), pp. S22-7. doi:10.1016/j.semarthrit.2015.11.009.
    Pelletier JP, et al. Efficacy and Safety of Oral NSAIDs and Analgesics in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S22-7. PubMed PMID: 26806184.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. AU - Pelletier,Jean-Pierre, AU - Martel-Pelletier,Johanne, AU - Rannou,François, AU - Cooper,Cyrus, Y1 - 2015/12/02/ PY - 2015/10/12/received PY - 2015/11/18/revised PY - 2015/11/25/accepted PY - 2016/1/26/entrez PY - 2016/1/26/pubmed PY - 2016/12/15/medline KW - Analgesics KW - Coxibs KW - Cyclo-oxygenase-2 (COX-2) inhibitors KW - Knee osteoarthritis KW - Oral non-steroidal anti-inflammatory drugs (NSAIDs) KW - Tramadol SP - S22 EP - 7 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 45 IS - 4 Suppl N2 - Non-steroidal anti-inflammatory drugs (NSAIDs) are at the cornerstone of treatment for osteoarthritis (OA). In recent years, the widespread use of oral NSAIDs has been called into question due to the appearance of significant upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events (AEs). However, NSAIDs are non-homogeneous, and there are noticeable differences between them in AE risk for GI and CV events. Nevertheless, if properly prescribed oral NSAIDs can provide an effective and safe treatment for OA in real-life situations. The identification of patients with significant CV and/or GI risk is critical, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm provides guidance on appropriate treatments for OA patients with elevated risk. Among non-selective NSAIDs, ibuprofen and naproxen seem preferable to diclofenac, the latter being associated with higher CV risk. Recommendation has been made by some that naproxen may be the preferred agent in patients at high CV risk because of its lower risk of CV events. Low dose celecoxib (200mg/day) is also associated with a lower risk of CV events compared with other coxibs. In addition, drugs with a demonstrated low GI risk profile may be of benefit, such as coxibs and nabumetone. Among patients who fail to respond adequately to sequential ESCEO algorithm Step 1 and Step 2 treatments, the short-term use of weak opioids, such as tramadol, for severely symptomatic OA patients is recommended. Although studies exploring the efficacy of tramadol in OA are limited, there is good evidence that tramadol works if prescribed properly. The sustained-release (SR) formulation of tramadol is preferred as it avoids the peak plasma concentrations reached with immediate-release tramadol, and is believed to reduce the incidence of AEs. Furthermore, slow upwards titration of tramadol SR is recommended to improve tolerability and minimize treatment discontinuations. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/26806184/Efficacy_and_safety_of_oral_NSAIDs_and_analgesics_in_the_management_of_osteoarthritis:_Evidence_from_real_life_setting_trials_and_surveys_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(15)00287-5 DB - PRIME DP - Unbound Medicine ER -