scholarly journals Local anti-inflammatory therapy for osteoarthritis with high comorbidity

2021 ◽  
pp. 155-162
Author(s):  
I. G. Krasivina ◽  
L. N. Dolgova ◽  
N. V. Dolgov
Keyword(s):  
Adverse Events ◽  
Analgesic Efficacy ◽  
Evidence Base ◽  
Ease Of Use ◽  
Knee Joints ◽  
Duodenal Ulcers ◽  
Antiinflammatory Therapy ◽  
Anti Inflammatory ◽  
Topical Medications ◽  
High Comorbidity

Osteoarthritis (OA) is a widespread disease, the leading symptom of which is pain in the load-bearing joints, and the incidence increases with age. Many patients with OA have several comorbidities, such as arterial hypertension, coronary heart disease, diabetes mellitus, gastric and duodenal ulcers. Currently, there are different approaches to the treatment of OA with and without comorbidity. In particular, oral non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended for OA with high comorbidity. The literature review discusses the prospects and popularity of the use of local forms of NSAIDs associated with their equal analgesic efficacy relative to oral drugs, but with a smaller number of adverse events. Data on transcutaneous forms of diclofenac are analyzed, which can provide at least oral equivalent analgesia, improved physical function and reduced stiffness in  osteoarthritis of  the  hands and knee joints, while showing fewer systemic adverse events. This feature of  topical NSAIDs allows them to be considered as an effective first-line treatment option, especially in elderly patients and those with severe comorbidity. Topical medications containing diclofenac as the main active ingredient are popular among both patients and doctors, and their use has an extensive evidence base. Diclofenac ethylenediamine salt has advantages over sodium salt in its penetrating properties, and the form of an emulsion gel containing a hydrophobic phase that slows down the drying of the substance applied to the skin provides ease of use and improves the consumer properties of agents for local antiinflammatory therapy of osteoarthritis.

scholarly journals GPs’ views and experiences of prescribing non-steroidal anti-inflammatory drugs: a qualitative study

BJGP Open ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. bjgpopen17X100869 ◽  
Author(s):  
Janet McDonald ◽  
Lynn McBain ◽  
Anthony C Dowell ◽  
Caroline Morris
Keyword(s):  
Adverse Events ◽  
Structured Interview ◽  
Evidence Base ◽  
Mitigation Strategies ◽  
Individual Interviews ◽  
Risks And Benefits ◽  
Data Saturation ◽  
Potential Benefits ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in primary care despite being a high-risk drug group causing significant adverse events, yet little is known about GPs’ perceptions of NSAID risks and benefits.AimTo explore GPs’ experiences with NSAID prescribing and views about the risks and benefits of this group of medicines.Design & settingA qualitative, inductive study in general practice.MethodIndividual interviews with 15 GPs using a semi-structured interview guide. Interviews were audiorecorded and transcribed. An inductive, thematic approach was used for analysis. Sampling continued until data saturation was achieved.ResultsThree main themes illustrate GPs’ key concerns with managing NSAID risks. The first theme was perceptions of risks and benefits of NSAIDs: GPs expressed differing attitudes towards prescribing medication generally. GPs were aware of the general risks of NSAIDs but weighed these up against specific risk factors and potential benefits for particular patients. They were most concerned about long-term use, risks for children, older people, and patients with comorbidities. The second theme was assessing and mitigating risks when prescribing NSAIDs: GPs considered gastric, cardiac, and renal risks of patients as well as drug interactions. Mitigation strategies included alternative treatment, choice and dose of NSAID, and use of gastroprotective agents. The final theme was other factors impacting on NSAID risks: particularly patient expectations and over-the-counter (OTC) availability.ConclusionNSAID prescribing is a complex balance between pragmatism and potential adverse events. Given the costs of morbidity, hospitalisation, and patient demand there is an urgent need to secure a more detailed evidence base and develop practical pathways to support safer prescribing.

scholarly journals Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

2007 ◽  
Vol 12 (1) ◽  
pp. 13-21 ◽  
Author(s):  
DE Moulin ◽  
AJ Clark ◽  
I Gilron ◽  
MA Ware ◽  
CPN Watson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Ease Of Use ◽  
Control Group ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Analgesic Agents ◽  
Third Line

Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

scholarly journals The Cost-effectiveness of Celecoxib versus Non-steroidal Anti-inflammatory Drugs plus Proton-pump Inhibitors for Treating Osteoarthritis in Algeria

10.36469/9865 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 184-199 ◽  
Author(s):  
Nadir Hammoumraoui ◽  
Sid Ahmed Kherraf ◽  
Joaquin Mould-Quevedo ◽  
Tarek A. Ismail
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Proton Pump ◽  
Cost Effective ◽  
Private Clinic ◽  
Effective Treatment Option ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Cyclooxygenase-2 inhibitors such as celecoxib are as effective as non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) in the treatment of osteoarthritis (OA), have fewer gastrointestinal side effects, but are more expensive. Objective: To evaluate the incremental cost-effectiveness ratio (ICER) of celecoxib versus ns-NSAIDs, with/without proton-pump inhibitor (PPI) co-therapy, for treating OA in Algeria. Methods: The National Institute for Health and Clinical Excellence (NICE) health economic model from UK, updated with relative risks of adverse events using CONDOR trial data, was adapted for costeffectiveness analysis in OA patients aged ≥65 years. Patients could initiate treatment with celecoxib or ns-NSAIDs with/without omeprazole. Conditional probabilities were obtained from published clinical trials; effectiveness measure was quality-adjusted life years (QALYs) gained/patient. The analysis was conducted from a healthcare payer’s perspective. The average daily treatment costs and frequencies of resource use for adverse events were based on data collected in August 2011 from a private clinic located in Cheraga, Algiers, Algeria. Probabilistic sensitivity analysis (PSA) was performed to construct cost-effectiveness acceptability curves (CEACs). Results: QALYs gained/patient over a 6-month horizon were higher with celecoxib (0.368) and celecoxib+PPI (0.40) versus comparators. The lowest expected cost/patient was associated with ibuprofen (US$134.76 versus US$175.67 with celecoxib+PPI, and US$177.57 with celecoxib). Celecoxib+PPI was the most cost-effective drug treatment, with an ICER of US$584.43, versus ibuprofen. Treatment with celecoxib alone showed an ICER of US$1,530.56 versus diclofenac+PPI. These ICERs are <1 gross domestic product per capita in Algeria (US$7,500). Over 1-year, 3-year and 5-year horizons, celecoxib with/without PPI co-therapy showed higher QALYs/patient versus comparators, and decreasing ICERs. The ICER of celecoxib+PPI was lower than that of comparators over all time horizons. These findings were confirmed with CEACs generated via PSA. Conclusion: Using data from a single private clinic in Cheraga, Algiers, Algeria, and after considering new adverse event risks, we showed that celecoxib with/without PPI co therapy is more cost-effective than ns-NSAID+PPI for treating OA patients aged ≥65 years. Celecoxib+PPI remains dominant over a 5-year horizon, making it the most cost-effective treatment option for medium- and long-term use.

scholarly journals Acute Myopericarditis in a Pediatric Patient after First Dose of Pfizer BioNTech COVID - 19 Vaccination: First Case Report in the Kingdom of Bahrain

2021 ◽  
Vol 33 (4) ◽  
pp. 29-32
Author(s):  
Ghada Al Qassim ◽  
Vimalarani Arulselvam ◽  
Suad R Al Amer ◽  
Salah Al Ghanem ◽  
Neale Nicola Kalis
Keyword(s):  
Case Report ◽  
Adverse Events ◽  
Pediatric Patient ◽  
Task Force ◽  
Limited Data ◽  
First Case ◽  
National Task ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Coronavirus disease 201 9 (COVID - 1 9 ) vaccination for children over 12 years of age began on May 2021 in the kingdom of Bahrain. Very limited data is available regarding the adverse events related to COVID -19 vaccination in children. This is a case report of a 12-year-old previously healthy boy with acute myopericarditis who presented on day 5 after the first dose of Pfizer COVID - 19 vaccination. Other causes of acute myopericarditis were ruled out. He was treated with non - steroidal anti-inflammatory drugs and recovered fully. This case of vaccine-induced myocarditis was reported to the national task force of Bahrain for combating COVID - 19.

scholarly journals Lactoferrin and Its Potential Impact for the Relief of Pain: A Preclinical Approach

2021 ◽  
Vol 14 (9) ◽  
pp. 868
Author(s):  
Beatriz Godínez-Chaparro ◽  
Fabiola Guzmán-Mejía ◽  
Maria Elisa Drago-Serrano
Keyword(s):  
Pain Treatment ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Kidney Injury ◽  
Analgesic Efficacy ◽  
Intestinal Bleeding ◽  
Ulcer Formation ◽  
Analgesic Effects ◽  
Density Lipoprotein Receptor ◽  
Anti Inflammatory

Pain is one of the most disabling symptoms of several clinical conditions. Neurobiologically, it is classified as nociceptive, inflammatory, neuropathic and dysfunctional. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are conventionally prescribed for the treatment of pain. Long-term administration of opioids results in the loss of analgesic efficacy, leading to increased dosage, tolerance, and addiction as the main drawbacks of their use, while the adverse effects of NSAIDs include gastric ulcer formation, intestinal bleeding, acute kidney injury, and hepatotoxicity. Lactoferrin is an iron-binding, anti-inflammatory glycoprotein that displays analgesic activities associated, in part, by interacting with the low-density lipoprotein receptor-related protein (LRP), which may result in the regulation of the DAMP–TRAF6–NFκB, NO–cGMP–ATP K+-sensitive channel and opioid receptor signaling pathways. This review summarizes and discusses for the first time the analgesic effects of lactoferrin and its presumable mechanisms based on pre-clinical trials. Given its anti-nociceptive and anti-inflammatory properties, lactoferrin may be used as an adjunct to enhance the efficacy and to decrease the tolerogenic effects of canonical therapeutic drugs prescribed for pain treatment.

Safety and Efficacy of the Cyclooxygenase-2 Inhibitors Parecoxib and Valdecoxib after Noncardiac Surgery

2006 ◽  
Vol 104 (3) ◽  
pp. 518-526 ◽  
Author(s):  
Nancy A. Nussmeier ◽  
Andrew A. Whelton ◽  
Mark T. Brown ◽  
Girish P. Joshi ◽  
Richard M. Langford ◽  
...  
Keyword(s):  
Adverse Events ◽  
Artery Bypass ◽  
Opioid Analgesic ◽  
Analgesic Efficacy ◽  
Noncardiac Surgery ◽  
Double Blind ◽  
Related Symptom ◽  
Pain Ratings ◽  
Gastroduodenal Ulceration

Background Valdecoxib and its intravenous prodrug parecoxib are reported to increase thromboembolic risk after coronary artery bypass grafting. The authors conducted a randomized trial to examine their safety and analgesic efficacy in patients recovering from major noncardiac surgical procedures. Methods The trial was randomized and double-blind, with 10 days of treatment and 30 days of follow-up. Patients (n = 1,062) received either parenteral parecoxib for 3 days and oral valdecoxib for the rest of the treatment period or placebo medications throughout. The frequency of predefined adjudicated postrandomization adverse events, including cardiovascular thromboembolism, renal dysfunction, gastroduodenal ulceration, and wound-healing complications, was assessed in each group. Secondary efficacy endpoints included patients' pain ratings, opioid analgesic consumption (recorded as morphine equivalents), and reports of opioid-related adverse effects. Results Predefined adjudicated adverse events had similar frequencies among patients who received parecoxib and valdecoxib (2.7%) and placebo patients (3.2%) (P = 0.58), including cardiovascular thromboembolic events (1.0% in each group; P = 1.0). Placebo patients consumed more morphine equivalents (66.2 +/- 92.4 mg) than did patients receiving parecoxib and valdecoxib (43.2 +/- 65.7 mg) (P < 0.001). Placebo patients had higher mean pain ratings on each of study days 2-10 (P < 0.01) and reported more opioid-related symptom distress on days 2-6 (P < 0.01). Conclusions Parecoxib and valdecoxib are useful adjuncts to opioids for the treatment of postoperative pain in noncardiac surgical patients. Further study will be required to determine the safety profile of parecoxib and valdecoxib administered to patients with known atherosclerotic disease after noncardiac surgery.

Clinical and economic implications of upper gastrointestinal adverse events in Asian rheumatological patients on long-term non-steroidal anti-inflammatory drugs

2018 ◽  
Vol 21 (5) ◽  
pp. 943-951 ◽  
Author(s):  
Lydia Say Lee Pok ◽  
Fatiha Hana Shabaruddin ◽  
Maznah Dahlui ◽  
Sargunan Sockalingam ◽  
Mohd Shahrir Mohamed Said ◽  
...  
Keyword(s):  
Adverse Events ◽  
Economic Implications ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Gastrointestinal Adverse Events ◽  
Upper Gastrointestinal

scholarly journals Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps

2019 ◽  
Vol 70 (3) ◽  
pp. 320-326
Author(s):  
Kathryn E. Darras ◽  
Jeroen J. G. van Merriënboer ◽  
Matthew Toom ◽  
Nathan D. Roberson ◽  
Anique B. H. de Bruin ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Experience ◽  
Mobile Apps ◽  
Statistical Significance ◽  
Image Interpretation ◽  
Evidence Base ◽  
Ease Of Use ◽  
Content Organization ◽  
Learner Preferences ◽  
Delivery Strategies

Purpose There is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning). Methods An online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05. Results The response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important ( P < .01) and quizzes as less important ( P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable. Conclusion This study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.

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